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unit 14 health and social care
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Unit 14 Task 2 Learning aim DIntroduction – Rose
Rose struggled with pain and stiffness in her right hip. She was diagnosed with osteoarthritis
and was put on anti-inflammatory medication and was told she can come back if it gets
worse. She is 60 years old lives alone as her husband died of a heart attack two years ago.
Her daughter struggles to visit her but finds it difficult due to her work, childcare and her
husband always using the car so the journey is difficult. Since Rose was diagnosed she has
been using pain relief as suggested and adopted a cane to help her walk and said she ‘has
no complaints’. She took early retirement and does charity work in the community. The
arthritis has not affected her ability to do so. Recently she came back to the surgery with
severe pain in her hip and knee and also experiencing sore and stiff fingers. She was
referred to a surgeon for a hip replacement. It was suspected she was showing symptoms
rheumatoid arthritis and was sent for blood tests and scans.
Diagnosis of rheumatoid arthritis
Rheumatoid arthritis is often hard to diagnose as many conditions cause joint stiffness and
inflammation and there is also no definitive test for the condition. Rose was sent to have a
blood test, however no blood test can prove the diagnosis but can show indications. She
was sent for a C-reactive protein test which measures inflammation levels. She was also
sent for a rheumatoid factor blood test. This will measure the levels of rheumatoid factors in
the blood which are a type of protein. High levels of this protein can indicate signs of
diagnosis however, 1 in 20 individuals without rheumatoid arthritis also test positive. Blood
tests for rheumatoid arthritis are not 100% accurate and you can still be tested positive
without signs in blood tests. However, it can give us indications and allow us to do further
testing to be precise. Rose was also sent for a scan. Scans check for joint flammation and
damage, which Rose had mentioned she was having. A scan can distinguish between the
different types of arthritis and give a
clearer picture of what Rose may have. The scan can also monitor how the arthritis has
progressed over time and show if it has gotten worse. The scans include an X-ray and MRI
scans.
Treatment
Treatment for rheumatoid arthritis involves reducing inflammation in the joints, relieve pain,
prevent or slow down joint damage, reduce disability and enable you to be more physically
active in everyday life. There is no cure for rheumatoid arthritis, however early treatment and
support such as medication, lifestyle changes, supportive treatments and surgery can limit
the impact of the condition and reduce the risk of further damage to joints. This treatment will
involve your GP and other specialists. The medication involved is divided between two main
types known as disease modifying anti-rheumatic drugs (DMARDs) and biological
treatments. During diagnosis, you are highly likely to be offered a combination of DMARD
tablets to ease
the symptoms and slow down the progression of further damage. DMARDs work by blocking
the chemicals produced from the immune system attacking the joints that could potentially
further damage bones, tendons, ligaments and cartilage. The types of DMARDs that may be
used methotrexate, leflunomide, hydroxychloroquine or sulfasalazine. Methotrexate is
usually the first medicine given to rheumatoid arthritis alongside another DMARD and a short
course of steroids to relieve pain and discomfort. Medication can be combined with biological
treatments. The common side effects of methotrexate involves feeling sick, loss of appetite,
sore mouth, diarrhoea, headaches and hair loss. The medication can also affect your blood
cells and liver therefore regular blood tests will be taken to monitor this. On a rare occasion,
methotrexate can affect the lungs, therefore chest X-rays and breathing tests are taken prior
to medication to provide a clear comparison in case a shortness of breath or a persistent dry
cough whilst taking it. However this is rare and most people can tolerate methotrexate. The
progress can be a few months to see if it is working, it is important that the medication is
taken regularly even if progress isn’t seen. Most individuals try round 2-3 types of DMARD
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