Rheumatoid Rosa — Rheumatoid Arthritis: Symmetric Joints, Morning Stiffness & DMARDs
Both hands, the same joints, every morning for over an hour — this is not wear and tear
Rosa wakes each morning with both hands swollen and locked. It takes 90 minutes of warm water and slow movement before she can hold a coffee cup.
Rosa's immune system attacks the synovial lining of her joints, so inflammation, not mechanical wear, drives the damage. That makes rheumatoid arthritis symmetric and systemic: the same joints on both sides, usually small joints of the hands and feet, with morning stiffness lasting more than an hour, plus fatigue, low-grade fever and weight loss. Osteoarthritis, by contrast, is asymmetric, worsens with use and stiffens for under 30 minutes. Untreated inflammation deforms joints, so DMARDs like methotrexate are started early — and methotrexate demands contraception, folic acid and lab monitoring.
Read Rheumatoid Rosa's full story →The story arc
The setup
Rosa, 58, notices both wrists and the same knuckles on both hands are swollen, warm and tender.
The turn
Her morning stiffness lasts over an hour and improves with gentle movement; she is also exhausted and has lost weight.
The crisis
Without treatment her fingers begin to drift outward at the knuckles and she can no longer grip a jar.
The save
Rosa starts methotrexate with folic acid and monitoring, uses heat before activity and cold for flares, paces tasks, and uses assistive devices.
NCLEX study section — Rheumatoid Arthritis: Symmetric Joints, Morning Stiffness & DMARDs
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Health Assessment
Take this chapter into practice questions on the same topic.