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anti-inflammatory drugs

Other Drugs: Interleukin-1 receptor inhibitors such as anakinra (Kineret). Disease-modifying agents used in various combination therapy regimens: methotrexate, hydroxychloroquine, gold, D-penicillamine, sulfasalazine, cyclosporine A, minocycline, azathioprine, leflunomide, infliximab, and etanercept.

Independent

Teach the patient assistive techniques to manage joint pain, such as meditation, biofeedback, and distraction. Advise the patient to take warm to hot showers or baths in the morning or evening to help relieve the pain. During acute stages of the disease, encourage the patient to avoid exercising the inflamed joints; help the patient understand the need to rest; however, patients do need to maintain mobility and movement of joints that are not involved. Provide necessary assistance with the activities of daily living, and prevent flexion contractures by having the patient lie prone with the feet hanging between the mattress and the footboard several times a day. Keep the patient warm, and provide meticulous skin care.

During subacute and chronic stage of RA, the patient needs to return to as much independence as possible. When mobility improves, encourage the patient to assume more responsibility for self-care. Promote adequate rest, especially after activity, and plan rest periods during the day. Assist the patient with nutrition to prevent anorexia, which contributes to anemia, thus causing further weakness and activity intolerance. Determine whether the patient has a firm mattress and straight-back chairs with arm rests at home to support proper positioning. Show the patient how to avoid flexion contractures of the large muscle groups while sleeping and sitting.

Teach the patient to avoid putting pillows under the legs while sitting and sleeping and to avoid sitting in soft, low chairs. When the acute inflammatory stage subsides and the patient is ready for discharge from the hospital, teach him or her to take medications as prescribed, stressing the need to maintain therapeutic blood levels of the drug. Suggest that the patient use dressing aids such as a long-handled shoehorn, elastic shoelaces, a zipper pull, and a buttonhook. Recommend the use of hand-held shower nozzles, grab bars, and hand rails. As RA progresses and deformity become pronounced, patients may suffer with body image disturbances and inability to engage in sexual activity. Assist the patient and partner to cope with these problems.

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