) is a chronic, systemic inflammatory disease involving connective tissue and characterized by
destruction and proliferation of the synovial membrane, resulting in joint destruction, ankylosis, and deformity.
Although the cause is unknown, researchers speculate that a virus may initially trigger the body’s immune response,
which then becomes chronically activated and turns on itself (autoimmune response). Immunologic mechanisms appear
to play an important role in the initiation and perpetuation of the disease in which spontaneous remissions and
unpredictable exacerbations occur. RA is a disorder of the immune system and, as such, is a whole-body disease that
can extend beyond the joints, affecting other organ systems, such as the skin and eyes.
Community level unless surgical procedure is required.
Psychosocial aspects of care
Total joint replacement
Patient Assessment Database
Data depend on severity and involvement of other organs (e.g., eyes, heart, lungs, kidneys), stage (i.e., acute
exacerbation or remission), and coexistence of other forms of arthritis/autoimmune diseases.
Joint pain and tenderness worsened by movement and stress placed on joint; morning
stiffness (duration often l hr or more), usually occurs symmetrically
Functional limitations affecting ADLs, desired lifestyle, leisure time, and occupation
Fatigue; sleep disturbances
Impaired ROM of joints; particularly hand (fingers and wrist), hips, knees, ankles, elbows,
Muscle atrophy; joint and muscle contractures/deformities
Decreased muscle strength, altered gait/posture
Intermittent pallor, cyanosis, then redness of fingers/toes before color returns to normal
Acute/chronic stress factors (e.g., financial, employment, disability, relationship factors)
Hopelessness and powerlessness (incapacitating situation)
Threat to self-concept, body image, personal identity (e.g., dependence on others)
Inability to obtain/consume adequate food/fluids (temporomandibular joint [TMJ]
Dryness of oral mucous membranes, decreased oral secretions; dental caries (Sjögren’s
Varying difficulty performing self-care activities; dependence on others