Signs of infection in a patient on immunosuppressants (methotrexate, biologics) require prompt reporting.
Before you read
Test yourself first: 2 questions
Question 1 of 2
The nurse is caring for a client with osteoarthritis of the knees. Which characteristic of the joint pain helps distinguish osteoarthritis from rheumatoid arthritis?
Answer: B. Osteoarthritis is a degenerative joint disease in which pain typically worsens with activity and weight bearing and improves with rest, and morning stiffness is brief (usually under 30 minutes). Rheumatoid arthritis features prolonged morning stiffness and symmetric inflammatory joint involvement.
Question 2 of 2
A child with a recent streptococcal infection develops migratory joint pain, carditis, and involuntary movements. The nurse recognizes this as a complication of which untreated infection?
Answer: A. Acute rheumatic fever is a delayed inflammatory complication of untreated group A streptococcal pharyngitis. It can cause carditis, migratory polyarthritis, and chorea. Prompt antibiotic treatment of strep throat prevents it.
Keep the streak going with more questions like these, each with a full rationale.
What is rheumatoid arthritis?
Unlike osteoarthritis, it affects joints bilaterally and is accompanied by systemic symptoms like fatigue and fever. It tends to flare and remit and is more common in women.
Rheumatoid Arthritis illustrated
Key points to remember
- Joint involvement is symmetric and bilateral, classically affecting the small joints of the hands and feet.
- Morning stiffness lasting longer than one hour is a hallmark and improves with activity.
- Systemic symptoms include fatigue, low-grade fever, weight loss, and malaise.
- Chronic inflammation causes deformities such as ulnar drift, swan-neck, and boutonniere of the fingers.
- Subcutaneous rheumatoid nodules may appear over bony prominences.
- Positive rheumatoid factor and anti-CCP antibodies support the diagnosis.
Signs & symptoms
- Symmetric small joints (hands/wrists)
- Morning stiffness > 1 hr
- Swelling, warmth, fatigue, fever
Nursing priorities
- Apply heat for chronic stiffness and cold to acutely inflamed joints to manage pain.
- Encourage a balance of rest during flares and gentle range-of-motion exercise to preserve function.
- Administer DMARDs (methotrexate), NSAIDs, and corticosteroids as ordered and monitor for side effects.
- Promote use of assistive devices and joint protection techniques.
- Schedule activities to allow rest periods and conserve energy.
Labs & values
Patient teaching
- Take methotrexate exactly as prescribed, avoid alcohol, use sun protection, and report mouth sores or fever.
- Apply heat for stiffness and cold for swelling, and perform gentle range-of-motion exercises daily.
- Balance activity with rest, use larger joints for tasks, and avoid prolonged gripping to protect joints.
Red flags: report now
- Signs of infection in a patient on immunosuppressants (methotrexate, biologics) require prompt reporting.
- Methotrexate toxicity (mouth sores, severe fatigue, bleeding, liver changes) must be reported immediately.
- Sudden severe joint pain, swelling, and warmth may indicate septic arthritis rather than a flare.
References
Clinical references for this topic
