Introduction
The collected health history on the patient suggests that the woman is at risk for developing rheumatoid arthritis. The latest research shows that many causative risk factors can be mitigated to prevent the onset of the disease or reduce its impact. A modifiable lifestyle aspect associated with the condition is smoking. This report will seek to identify how modifying a high-risk behavior in the patient through intervention and education can lead to improved outcomes and the offset of arthritis symptoms.
Preventable Disease Overview
Rheumatoid arthritis is a chronic and autoimmune inflammatory disease. The pathophysiology of the disease includes the immune system malfunctioning when white blood cells begin to attack healthy tissue in the joints. As a result, there is evident inflammation, swelling, stiffness, and pain in the joints. The inflammation of the synovial membrane causes a release of enzymes that damage cartilage and ligaments in the area. There is bone and cartilage loss and tear. The joints may become damaged or misaligned (Harvard Health Publishing, 2013).
Rheumatoid arthritis diagnosis begins with collecting medical history and conducting a physical exam. A physician may check joints to determine tenderness, swelling, and limited movement. Furthermore, blood tests are ordered to measure rheumatoid factor antibodies (found in 80% of cases) and inflammation (ESR and C-reactive protein levels) (Arthritis Foundation, n.d.).
Symptoms include pain and swelling in joints that cause pain and limited range of motion. Furthermore, the person may experience soreness and stiffness, with chronic fatigue and aches. Other factors include unusual weight loss, problems with sleep, and low-grade fever (Harvard Health Publishing, 2013). The patient demonstrated these characteristics based on their health history. They have experienced perpetual inflammation and pain in joints, with decreased range of motion. The patient also mentioned fatigue and some issues with sleep. The symptoms exhibited by the patient as well as environmental and behavioral factors (high impact exercise and smoking) were the basis for the identification of risk for this disease.
Evidence-Based Intervention
The best evidence-based intervention selected for this patient is smoking cessation. This is achieved through a combination of methods including education, use of support structures, and pharmacological substances to reduce nicotine dependency. Behavioral interventions can include consultation with a medical professional, therapy, support groups, and the use of reminders through text messaging. Pharmacological interventions usually make use of products that deliver nicotine into the bloodstream in regulated dosages, gradually wearing off a patient’s dependence. This can consist of transdermal patches, nicotine lozenges, or specific chewing gum (West et al., 2015). The short-term goal for the patient includes gradually reducing the daily number of smoked cigarettes with the aid of nicotine delivery products. A long-term goal is a cessation of smoking without the use of nicotine products.
Without a known genetic predisposition (based on family history), causes for rheumatoid arthritis are often environmental. One of the primary established risk factors is smoking. This behavior increases the probability of developing an anti-citrullinated peptide antibody which positively correlates with rheumatoid arthritis. Prolonged and high-intensity smoking cause immunomodulation. The antibody production becomes dysfunctional leading to cellular pathology which increases the risk of arthritis. Cessation of smoking results in a gradual disappearance of these cells from the body, supporting the evidence that reduction in this behavior can lead to the declined incidence of the disease (Hedström, Stawiarz, Klareskog, & Alfredsson, 2018).
Implementation
The intervention to quit smoking is a complex and challenging process that will require a combination of methods to achieve success. It is recommended to begin the process by selecting a specific date in the upcoming weeks to cease smoking. First, the patient should be consulted and educated on the dangers of smoking, including its risks for the development of rheumatoid arthritis. The participant should outline their personal reasons to quit smoking as well. It is recommended to construct a support system that one could rely on for assistance and accountability. Patients should be aware of various nicotine withdrawal symptoms, triggers, and psychological pressures that occur during the first weeks of quitting. It is recommended to implement behavioral changes such as lifestyle choices and problem-solving skills which may help to manage any cravings.
The participant should be aware that relapses may occur and be able to work around them (Rigotti, 2018). Resources provided to the participant include various medical organizations and government websites which provide recommendations and guidelines on how to quit smoking. The Centers for Disease Control and Prevention offers numerous information sources on the impacts of smoking. Furthermore, a free support hotline exists in the United States which assists a person to manage the addiction.
Evaluation
After a period of several months of abstinence from smoking, the patient should see a physician to evaluate how the intervention has impacted her health and joints. A physical examination should be conducted to evaluate whether or not inflammation has been reduced. Blood tests can be done to measure the level of antibodies and CRP levels. If the intervention proves to be ineffective, the patient should continue abstinence from smoking. However, a physician may recommend treatments such as physical therapy and prescription medication to treat arthritis once it is officially diagnosed.
Summary
Rheumatoid arthritis is identified as an at-risk condition for the participant. Autoimmune diseases cause inflammation and pain in the joints. Without a genetic predisposition, a specific environmental factor of smoking is considered the primary risk in this patient. The intervention consists of encouraging the participant to cease smoking. According to evidence-based research, it should reduce the risk factor or impact of the disease significantly. While arthritis is not traditionally considered a preventable condition, there are numerous behavioral and environmental aspects that can be modified to decrease its incidence.
References
Arthritis Foundation. (n.d.). Rheumatoid arthritis diagnosis. Web.
Harvard Health Publishing. (2013). Rheumatoid arthritis. Web.
Hedström, A. K., Stawiarz, L., Klareskog, L., & Alfredsson, L. (2018). Smoking and susceptibility to rheumatoid arthritis in a Swedish population-based case–control study. European Journal of Epidemiology, 33(4), 415-423. Web.
Rigotti, N. A. (2018). Patient education: Quitting smoking (beyond the basics). Web.
West, R., Raw, M., McNeill, A., Stead, L., Aveyard, P., Bitton, J.,… Borland, R. (2015). Health-care interventions to promote and assist tobacco cessation: A review of efficacy, effectiveness and affordability for use in national guideline development. Addiction, 110(9), 1388-1403. Web.