The principles of inflammation in the development of rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory condition that involves all elements of the immune response. The aetiology of RA is complex and centres on the development of autoantibodies and immune complexes. The pathogenesis is multistage and involves cytokines, angiogenesis and rheumatoid factor. Nurses managing patients who suffer with RA need to be aware of the pathological changes involved in the disease and its contribution to the progression of the condition. The diagnosis of RA involves blood screening for rheumatoid factor, raised erythrocyte sedimentation rate (ESR), use of arthroscopy to provide evidence of histological changes in the synovium, presenting symptoms, and changes on X-ray. Patient assessment will consider both patient-specific and disease-specific variables, including evidence of non-articular manifestations of RA. Long-term care revolves around trying to maintain patient mobility and the protection of unaffected joints, monitoring for the side-effects from medication and progression of the disease or development of non-articular manifestations.