What happens in the joint to cause so much pain?
The membrane lining the joint (synovium) becomes inflamed. Over time the inflammation can lead to damage in bones, joints as well as other organs. There are basically 3 stages in RA:
- Early: Patients have pain, warmth, and stiffness in joints due to the synovium inflammation.
- Moderate: Bone destruction is visible by Xray. Continued inflammation leads to pannus formation.
- Severe: Osteoclasts and fibroblasts release enzymes that digest cartilage and bone which causes severe bone destruction and joint deformities as well as muscle wasting.
What is a cytokine?
A soluble protein produced by many cell types that is not an antibody but is involved in mediating immune, inflammatory and allergic responses.
What is an infusion reaction? What are some signs and symptoms and what is going on in the patient’s immune system to cause these?
An infusion reaction is a reaction that occurs during or within 24 hours of an infusion. Signs and symptoms of this reaction may include but are not limited to hives, pruritis, hypo/hypertension, low back ache, edema, chest pain, SOB, headache, flushing, chills, etc. When a patient receives a biologic agent, that medication contains proteins that are different from the patient’s own and antibodies may be created to that medication.
How do you treat an infusion reaction?
Most reactions respond quickly to stopping the infusion,(if it is still being infused), providing diphenhydramine (or other antihistamine), acetaminophen and/or a steroid. Some reactions may require the use of epinephrine. Whatever treatment is provided, an emergency standing protocol should be in place for quick resolution of signs and symptoms.
Prior to starting an infusion, what do I need to know from my patient?
It is important to do an assessment on each patient every time they enter the infusion room. A checklist of things to ask may simplify this process. Some questions to consider are:
Have you been ill? Have you had any surgical treatment? Have you been to the dentist lately? Are you on any new medications? Are you taking an antibiotic? Do you have any new open wounds? How did you do after your last infusion? Have you been in the hospital in the last week or so? Do you have any new doctors? These are just a few of the questions to consider.
What is happening in an autoimmune disorder?
Generally speaking, autoimmune disease is a disease in which tissue damage occurs due to the body launching an adaptive immune response against its own cells that have been identified as antigens. In RA, macrophages, activated T cells and B cells accumulate at affected areas. They secrete cytokines such as IL-1, IL-6, and TNF which intensify and perpetuate inflammation leading to bone and joint destruction.
What lab tests are important in the diagnosis of RA and how often should they be monitored?
Sedimentation rates (ESR), C-reactive protein, Rheumatoid Factor (RF), ANA, HLA tissue typing, and CCP are important on the diagnosis/management of RA. The only tests that are done routinely to gauge disease activity are C-Reactive Protein and ESR. Other tests are also needed in the management of RA and those are liver functions, chemistry profiles, and CBC. Most lab values are checked every 6-8 weeks but the frequency of testing will depend on the medications prescribed and patient status.
How do we assess progress in our patients?
Progress may be assessed thru joint counts, general assessment, pain and fatigue scales, and a multitude of measurement tools which may include some or all of the following: questionnaires for patients, practitioner assessment, labs, and pain scales.
Will I hurt my patients if I touch them? I am scared to start IV’s on some of them !
No you will not necessarily hurt them. If you assess their discomfort before starting the IV you can determine an area you may want to stay away from. Remember from nursing school…patients need to feel the human touch!
