Orthopaedic Nurses Certification Board (ONCB) Metabolic/Inflammatory/Tumors Practice Exam

What finding should be documented in the medical record of a patient diagnosed with rheumatoid arthritis?

1. Early involvement of small joints

2. Few white cells in the synovial fluid

3. Presence of Heberden's nodes

4. Asymmetric narrowing of the joint space

The correct answer is: Early involvement of small joints

The documentation of early involvement of small joints is important for patients diagnosed with rheumatoid arthritis (RA) because this condition typically begins with the inflammation of small joints such as those in the hands and feet. This inflammation is a hallmark of the disease and is crucial for diagnosis and monitoring disease progression. Rheumatoid arthritis is characterized by symmetrically affected joints over time, with persistent synovitis leading to joint damage if not treated properly. Early detection and acknowledgment of joint involvement can help in implementing timely interventions to slow disease progression and prevent deformities. Other findings, while relevant in different contexts, are not indicative of the early stages or typical presentation of rheumatoid arthritis. For example, few white cells in the synovial fluid might indicate a different condition and does not fit the typical inflammatory profile associated with RA. The presence of Heberden's nodes relates more to osteoarthritis rather than rheumatoid arthritis, as these nodes form due to osteophyte formation and are not characteristic of RA. Likewise, asymmetric narrowing of the joint space is more associated with osteoarthritis, where joint space loss occurs unevenly, whereas RA tends to affect joints more symmetrically.