Pain Management in Rheumatoid Arthritis

By

Acknowledgement

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

DECLARATION

I, [type your full first names and surname here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the University.

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Abstract

The purpose of this review is to summarize psychosocial factors associated with arthritis pain and highlight recent data on psychosocial approaches to managing arthritis pain. By definition, the psychosocial factors related to the two dimensions of experience: psychological (cognitive, affective) and social (interacting with other people involved in life). Psychosocial factors affect the perception of pain and the presence of pain influences psychological well-being and social participation. After discussion, the effects of arthritis pain to participate in work, family life and leisure, as evidenced by the psychosocial interventions are summarized, emphasizing reviews and studies published from January 2000 to August 2006.As doctors, we have access to more potent therapies for diseases . With great power, however, must also come great responsibility. We must be cautious in our use of new treatments as they can have enormous costs, both financial and human, to our patients and society. Too often, we believe patients who do not respond to therapy simply takes longer or stronger treatments. of Lee and his colleagues reminds us that it is important to consider the human factor, existing outside of the underlying disease that may affect the results of treatment

Abbreviations

ANA antinuclear antibody

ACR American College of Rheumatology

anti-CCP anti-cyclic citrullinated peptide (antibody)

BMI body mass index

BSR British Society of Rheumatology

CI confidence interval

CRP C-reactive protein

DMARD disease modifying antirheumatic drug

EORA elderly onset rheumatoid arthritis

EPC Enhanced Primary Care

ESR erythrocyte sedimentation rate

EULAR European League Against Rheumatism

FBC full blood count

GIT gastrointestinal tract

GLA gamma- GLA gamma-linolenic acid

GP general practitioner

HR hazard ratio

LFT liver function tests

MA meta-analysis

MTX methotrexate

NNH number needed to harm

NNT number needed to treat

NHMRC National Health and Medical Research Council

NSAIDs non-steroidal anti-inflammatory drugs

OR odds ratio

OT occupational therapy

PMR polymyalgia rheumatica

RA rheumatoid arthritis

RCT randomised controlled trial

RhF rheumatoid factor

RACGP [The] Royal Australian College of General Practitioners

SMD standardised mean difference

SIGN Scottish Intercollegiate Guidelines Network

SR systematic review

TENS transcutaneous electrical nerve stimulation

TNF tumour necrosis factor

WMD weighted mean difference

Contents

CHAPTER 1: INTRODUCTIONVIII

Backgroundviii

Problem Statementviii

Rationaleix

Aims and Objectivesix

Significanceix

Research questionix

Limitation of the Studyx

CHAPTER 2: LITERATURE REVIEWXI

Disease Change ant rheumatic drugs (DMARDs)xii

Biological response modifiersxiv

Immunosuppressantsxv

Non-medical approaches:xvi

Relaxationxvi

Breathing exercisesxvii

Distractionxvii

Soliloquyxvii

Stress reductionxvii

CHAPTER 3: METHODOLOGYXX

Research Designxx

Literature Searchxx

CHAPTER 04: DISCUSSIONXXI

Multidisciplinary Care Planningxxi

Implications for nursesxxii

Nonsteroidal Anti-Inflammatory Drugs (Nsaids)xxvi

Corticosteroidsxxx

CHAPTER 5: CONCLUSIONXXXII

Implications for practice in nursingxxxiii

REFERENCESXXXVI

CHAPTER 1: INTRODUCTION

Background

Early inflammatory arthritis may be self limiting disease, developing in rheumatoid arthritis (RA), or differences in the other form of chronic arthritis. As in the case of other forms of arthritis, RA is believed to be a combination of genetic predisposition and exposure to relevant environmental triggers. This is the second most common form of arthritis and the most common autoimmune diseases in America 0.1 is a chronic, inflammatory joint disease of unknown ...