Respond to two of your colleagues and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not.
Initial Response: Case Study
Rheumatoid Arthritis is an inflammatory autoimmune disease with multiple genetic predispositions linked to its development when concurrent with environmental factors (Padyukov, 2022). Genetic risk factors are thought to occur by passing along dysfunctional genes responsible for delineating between self-made proteins and proteins created from outside factors such as infection (McCance & Huether, 2019, p. 1450). In this case study, a genetic link to RA makes this patient two to five times more likely to develop RA (Is Rheumatoid Arthritis Hereditary? Genetics and Risk Factors, 2018).
The patient presentation in this scenario has some red flag concerns and some factors that are less commonly observed in RA. As a 48-year-old male, this patient is less likely to develop RA due to age and sex. However, the presentation of edema in hands, location tenderness, fever, and malaise all give indication this patient is experiencing early symptoms of RA. The inflammation and pain are likely present due to the damage occurring in the synovial membrane. During RA, the body’s cytokines attack this membrane, converting it to a pannus, which increases pressure and reduces mobility in the affected joint (McCance & Huether, 2019, p. 1450). Development of RA is not related to repetitive movement, as associated with osteoarthritis. The patient’s job in this scenario could benefit and slow the impacts of RA, as maintaining joint movement is an essential factor for reducing symptoms of RA (Lovering, 2019).
The patient’s physiological response in this study will likely be present due to the previously covered genetic risk factors. Still, the patient must also meet the criteria for some environmental risk factors necessary to generate this response. Further questioning and investigation could lead to the revealing of risk factors such as smoking, obesity, or low socioeconomic status likely impacting nutrition (McCance & Huether, 2019, p. 1450). Smoking and a diet absent of Omega-3 fatty acids are thought to increase the likelihood of the body’s pathological response to the already present genetic factors triggering a cascade of immune response beginning with activation of the T-cells and B lymphocytes. These T-cells activate macrophages in the synovial lining and release enzymes that restructure this lining. As this progresses, joint deformities occur, reducing mobility and resulting in atrophy of surrounding muscle tissue (McCance & Huether, 2019, p. 1452).
A review of this study reveals the high importance of genetic factors that raise the suspicion of RA in this case. If the genetic predisposition were absent, it would likely cause further investigation, potentially from a different offender. It is essential to weigh all characteristics in this review, as early onset RA can present similarly to Lupus or other forms of arthritis. The distinguishing factor that allows us to key in on RA is the genetic predisposition in the family history (What’s the Difference between Lupus and RA?, 2018).
References
Is rheumatoid arthritis hereditary? Genetics and risk factors. (2018, October 29). Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/323495#is-ra-hereditaryLinks to an external site.
Lovering, C. (2019, February 11). Four Stages and Progression of Rheumatoid Arthritis. Healthline; Healthline Media. https://www.healthline.com/health/rheumatoid-arthritis/stages-and-progression#stages
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.
Padyukov, L. (2022). Genetics of rheumatoid arthritis. Seminars in Immunopathology, 44(1), 47–62. https://doi.org/10.1007/s00281-022-00912-0Links to an external site.
What’s the Difference Between Lupus and RA? (2018, November 5). Healthline. https://www.healthline.com/health/lupus-and-ra#differences
Peer 2
MondayMay 27 at 12:01pmManage Discussion Entry
Rheumatoid Arthritis
According to the patient, he suspected carpal tunnel syndrome, which he linked it to work environment. However, the symptoms he presents shows the patient suffers from inflammatory arthritis. One of the issues that could help affirm the diagnosis is the patient’s history, as subjective data indicates the presence of rheumatoid arthritis (RA) in his family.
Rheumatoid Arthritis
In medicine, RA falls under autoimmune diseases caused by misinterpretation of information by immune system, leading to cells of the body facing internal attack. Scientists are yet to figure out what may trigger immune cells to misbehave and attack the joints, causing chronic pain and swelling. However, genetic factors have been considered a plausible cause for RA. Patients from families with a history of RA are at increased risk of developing complications. However, not all people from these families will have the disease. Additionally, environmental factors present a certain level of risk, and this is often down to what a person does (Venetsanopoulou et al., 2022). For example, repetitive stress due to work obligations and other triggers may initiate an autoimmune response, and the risk is high in people with a family history of the disease (Jiang & Alfredsson, 2020). In the case of the patient, the family history shows that he is predisposed to RA due to his genes.
Symptoms
A wide range of symptoms confirms the presence of RA. According to the patient, the symptoms shown include stiffness, pain, and swelling in the joints, particularly the hands and wrists (Deane & Holers, 2021). The nature of work the client does and subjective data provided confirms RA. Another crucial detail relates to the chronic fatigue that the patient feels due to the chronic inflammatory process.
Physiologic response
In RA, the immune system mistakenly targets the synovium, the lining of the joints. Straining his hands at work may have triggered the autoimmune response (Tu et al., 2021). As such, the patient deals with chronic inflammation that contributes to thickening of the synovium and increased fluid production. The action puts the patient in distress, especially with stiffness, pain, and swelling of the joints.
Cells affected in RA
Since RA is an autoimmune complication, it targets joint tissues. Immune cells like macrophages, T-lymphocytes, and B-lymphocytes infiltrate the synovium, triggering chronic inflammation that further causes damage to joint tissues. This explains how the patient has been in chronic pain, as he rates pain in both hands at 5/10.
Impact of other characteristics
I believe that gender is important in the assessment of the patient. For example, women are considered at high risk for RA compared to men. Female hormones may negatively impact the immune system, triggering an autoimmune response. The second factor to consider is age. Often, most of the RA patients are diagnosed in their 40s and 60s with only a small percentage of RA diagnoses coming earlier than 40 years.
References
Deane, K. D., & Holers, V. M. (2021). Rheumatoid arthritis pathogenesis, prediction, and prevention: an emerging paradigm shift. Arthritis & Rheumatology, 73(2), 181-193.
Jiang, X., & Alfredsson, L. (2020). Modifiable environmental exposure and risk of rheumatoid arthritis—current evidence from genetic studies. Arthritis research & therapy, 22(1), 154.
Tu, J., Huang, W., Zhang, W., Mei, J., & Zhu, C. (2021). A tale of two immune cells in Rheumatoid Arthritis: The crosstalk between Macrophages and T Cells in the synovium. Frontiers in immunology, 12, 655477. https://doi.org/10.3389/fimmu.2021.655477
Venetsanopoulou, A. I., Alamanos, Y., Voulgari, P. V., & Drosos, A. A. (2022). Epidemiology of rheumatoid arthritis: genetic and environmental influences. Expert Review of Clinical Immunology, 18(9), 923-931.
