The Nurse Practitioner's Role in the Management of Rheumatoid Arthritis (2022)


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The Journal for Nurse Practitioners

Volume 7, Issue 10,

November–December 2011

, Pages 858-862, 870


Rheumatoid arthritis (RA) is a devastating illness that can have lifelong and potentially disabling consequences. Because the disease affects 1.29 million Americans, nurse practitioners (NPs) can expect to encounter a patient who suffers from this disease sometime during their career. Early diagnosis is crucial. The purpose of this article is to provide NPs an understanding of the clinical presentation and diagnosis, treatment options, and follow-up required for RA patients. With the current shortage of specialists to provide care to these patients, there will be increasing opportunities for NPs to partner with other health care providers to manage this patient population.


Section snippets

Clinical Presentation and Diagnosis

The NP, as a primary care provider, is typically the first person a patient sees after the onset of symptoms. Although pain is the most common motive to seek medical care, there can be many associated symptoms, and the patient can present at varying stages of the disease.3

Diagnosis is often based on the patient's history and clinical presentation.3, 4 When completing the health history, the NP should pay particular attention to the onset of symptoms as the inception of RA is usually subtle,

Treatment Options

Early, aggressive, and effective treatment is imperative in the management of RA because the end result will be a significant reduction in the disease progression.2, 7 If left untreated, 20% to 30% of patients with RA will become permanently work-disabled within 2–3 years of diagnosis, causing major economic loss.4 Approximately 50% of individuals diagnosed with RA will have substantial functional disability after 10 years of diagnosis, which is 4–15 times greater than the general population.2

Pharmacologic Management

The historical approach to the management of RA was to maintain the patient on non-steroidal anti-inflammatory drugs (NSAIDs) for as long as possible, only to add more potent medications when the patient's disease had progressed.1, 4 The current approach to management is to initiate a disease-modifying, anti-rheumatic drug (DMARD) within 3 months of diagnosis.1, 4

Pharmacologic management should be under the direction of a rheumatologist. However, there will be occasions when the NP will be


The NP needs to assess the nutritional and dietary status of RA patients. Symptoms can be worse in people who are overweight as a result of increased strain on the joints. Eating a diet that is high in fiber, low in fat and sugar, and contains plenty of fruit and vegetables can help maintain a healthy weight and provide the body with needed vitamins and minerals.8 Patients with RA are at risk for developing osteoporosis, so it is especially important to consume a diet high in calcium and

Disease Progression

The ACRSRA guidelines recommend that patient follow-up include ongoing evaluation for subjective and objective evidence of active disease.4 Assessment should include degree of joint pain, duration of morning stiffness and fatigue, presence of actively inflamed joints, and limitation of function. Loss or decrease in ROM, instability, misalignment, and deformity are evidence of disease progression.2 ESR and CRP elevation and evidence of disease progression on X-ray should also be assessed.2 NPs

Future Roles for the NP

The role of the NP will continue to grow with respect to RA. The emergence of chronic-disease management models will eventually encompass RA. NPs' training and expertise will guarantee them a role in managing this chronic disease.19

In the United Kingdom, NP rheumatology clinics have been proven to be feasible and cost-effective.19 Working in collaboration with the rheumatologists, these clinics have been able to provide comprehensive patient care and allow the rheumatologist to diagnose and


RA is a chronic disease that has the potential to cause significant distress and disability. The NP's role in management is invaluable and can be multifaceted. As a primary provider, the NP may be the first person the patient will see after the onset of symptoms. Diagnosis, referral to other providers, education, support, and follow-up are just some of the services the NP can provide. As the population ages, the need for providers proficient in RA management will increase, providing an

References (19)

  • A Golding et al.Rheumatoid arthritis and reproduction

    Rheum Dis Clin North Am


  • Rheumatoid arthritis. Centers for Disease Control and Prevention Web site

  • Mease PJ. Current clinical strategies for rheumatoid arthritis. Rheumatoid Arthritis: Meeting the Patient-Care...
  • HR Smith

    Rheumatoid arthritis

  • JA Rindfleisch et al.

    Diagnosis and management of rheumatoid arthritis

    Am Fam Physician


  • American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines

    Guidelines for the management of rheumatoid arthritis. 2002 Update

    Arthritis Rheum


  • AN Lee et al.

    Rheumatoid factor and anti-CCP autoantibodies in rheumatoid arthritis: a review

    Clin Lab Sci


  • S Bruce

    Recent developments in the treatment of rheumatoid arthritis

    J Pharm Pract


    (Video) The role of patient organisations in rheumatology

  • K Rennie et al.

    Nutritional management of rheumatoid arthritis: a review of the evidence

    J Hum Nutr Diet


There are more references available in the full text version of this article.

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View full text

Copyright © 2011 American College of Nurse Practitioners. Published by Elsevier USA All rights reserved.

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What is the best way to manage rheumatoid arthritis? ›

How to Handle Rheumatoid Arthritis Pain
  1. Take your pain medication on a schedule and as prescribed. ...
  2. Use a warm, moist compress to loosen up a stiff joint. ...
  3. Make it a priority every day to relax. ...
  4. Focus on things you enjoy.
  5. Join a support group. ...
  6. Exercise. ...
  7. Eat a healthy, balanced diet. ...
  8. Consider talking to a counselor.
Jun 15, 2021

What healthcare professionals are involved in rheumatoid arthritis? ›

Who to Include on Your Rheumatoid Arthritis Care Team
  • Primary care doctor. ...
  • Rheumatologist. ...
  • Physical and occupational therapists. ...
  • Dietitian. ...
  • Mental health professional. ...
  • Podiatrist. ...
  • Orthopedic surgeon.
Mar 20, 2014

How do you manage arthritis patients? ›

In many cases, arthritis symptoms can be reduced with the following measures:
  1. Weight loss. Excess weight puts extra stress on weight-bearing joints. ...
  2. Exercise. Regular exercise can help keep joints flexible. ...
  3. Heat and cold. Heating pads or ice packs may help relieve arthritis pain.
  4. Assistive devices.
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What are nursing considerations? ›

Nursing consideration and implications are generally summed up as being what a nurse needs to know and do in a particular situation.

What is the most effective treatment for arthritis? ›

NSAIDs. According to the American College of Rheumatology and the Arthritis Foundation (ACR/AF), nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most effective OTC remedies for managing osteoarthritis pain. NSAIDs can help reduce both pain and inflammation.

What is the latest treatment for rheumatoid arthritis? ›

Official answer. The newest drugs for the treatment of rheumatoid arthritis are the Janus kinase (JAK) inhibitors, which are FDA approved under the brand names Rinvoq, Olumiant, and Xeljanz.

How can you prevent rheumatoid arthritis? ›

There's no way to prevent RA, but you can lower your chances if you: Quit smoking. It's the one sure thing besides your genes that boosts your odds of getting RA. Some studies show it also can make the disease get worse faster and lead to more joint damage, especially if you're ages 55 or younger.

What healthcare professionals help with arthritis? ›

Who will treat you?
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  • Hand therapist. ...
  • Neurologist. ...
  • Occupational therapist. ...
  • Orthopaedic surgeon. ...
  • Orthotist. ...
  • Physiotherapist.

What is the role of a rheumatologist? ›

A rheumatologist is an internist or pediatrician who received further training in the diagnosis (detection), and treatment of diseases that affect the muscles, bones, joints, ligaments, and tendons. These diseases can cause pain, swelling, stiffness, and potentially cause joint deformities.

Who helps people with arthritis? ›

Rheumatologists are specialists in arthritis and diseases that involve bones, muscles and joints. They are trained to make difficult diagnoses and to treat all types of arthritis, especially those requiring complex treatment. You may be referred to an orthopedist if you have a type of degenerative arthritis.

Can you manage rheumatoid arthritis without medication? ›

You'll need to keep up with your usual medical care, but some natural remedies might help relieve pain and stiffness from rheumatoid arthritis (RA). Many of them are simple, like using heat and ice packs. Others, like acupuncture, need a trained pro.

What is rheumatoid arthritis treatment directed at? ›

Once a diagnosis is made, the main treatment goals are to control disease activity and slow the rate of joint damage, in addition to minimizing pain, stiffness, inflammation, and complications.

What is the nurse's role in supporting the patient? ›

Nurses keep track of their patients' health, provide medicine to them, take care of paperwork, help doctors diagnose patients, and provide advice, but their job doesn't stop here. As Study explains, they wear many hats throughout the working day, and meeting the emotional needs of their patients is one of them.

What are the 5 nursing interventions? ›

These are assessment, diagnosis, planning, implementation, and evaluation.

What are the 3 nursing interventions? ›

There are typically three different categories for nursing interventions: independent, dependent and interdependent.

What does a rheumatology nurse do? ›

A Rheumatology Nurse helps patients with rheumatic diseases that affect the joints and muscles, such as lupus, fibromyalgia, myositis, spondylitis, rheumatoid arthritis and Lyme disease.

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A patient with gout should avoid foods high in PURINES. These include most red meats, organ meats (liver, kidneys, sweetbreads), alcohol (especially beer). 2.

Which of the following are usually the first choice in the treatment of rheumatoid arthritis RA )? ›

Methotrexate is usually the first medicine given for rheumatoid arthritis, often with another DMARD and a short course of steroids (corticosteroids) to relieve any pain. These may be combined with biological treatments.

Which safety factor would the nurse teach parents about using a crib for an infant? ›

What safety factor should the nurse teach parents about using a crib for an infant? Check the slats are less than 6 cm (2.4 in) apart. If parents are using an older crib, they should check that the slats are less than 6 cm (2.4 in) apart.


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