Kindly could you proof read my paper?

Kindly could you proof read my paper? <br/><br/><br/> In the following

paragraphs, I will describe a chronic systemic inflammatory disease: rheumatoid arthritis (RA). In the description, I will elaborate on the types of drugs that a provider would prescribe to patients to treat associated symptoms of RA. Then, I will explain how the factor obesity might impact the effects of prescribed drugs, as well as any measures taken to help reduce negative side effects.
Rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease which involves the synovial lining of the joints  (Hammer, &amp; McPhee, 2014). In RA, the disease affects the diarthrodial joint which is the most common and movable type of joints (Hammer, &amp; McPhee, 2014). This inflammation causes cartilage destruction and progressive erosions; when worsening, they may cause joint destruction, disability or even death (Hammer, &amp; McPhee, 2014).  The clinic symptoms of RA swelling and pain of the affected joints and particularly, symptoms associated with RA are Sjogren’s Syndrome and Felty’s Syndrome (Hammer, &amp; McPhee, 2014). Sjogren’s Syndrome consists of ocular symptoms which present with dry eyes, mouth and mucous membrane (Hammer, &amp; McPhee, 2014). Felty’s Syndrome refers to the following symptoms splenomegaly and neutropenia  (Hammer, &amp; McPhee, 2014).
Treatment
The goal to manage of RA is mainly to decrease joint damage and pain, organ damage, reduce long-term complications, stop inflammation, and improve physical function (Adams, Holland, Bostwick, &amp; King, 2018). The following medications use for the management of RA nonsteroidal anti-inflammatory drugs (NSAID’s) are steroids and modifying anti-rheumatic drugs to decreases those symptoms (Huether, &amp; McCance, 2017). Therefore, clinicians would prescribed  NSAIDs which are drugs known to inhibit COX enzymes that convert arachidonic acid to prostaglandins responsible for inflammation. Thus, celecoxib mg by mouth daily could be prescribe with a watch for gastrointestinal disturbances(gastric ulcerations or bleed), renal side effects(hyperkalemia, hyponatremia) and platelets effect such as prolonged bleeding. Another prescribed medication will be a low-dose steroid such as an initial dose of prednisone 10 mg or equivalent (Arcangelo, Peterson, Wilbur, &amp; Reinhold, 2017). This low dose is beneficial in patients who are beginning DMARD therapy because the therapeutic effect of DMARDs take several weeks to months after initiating therapy when corticosteroids provide immediate symptom relief (Arcangelo, Peterson, Wilbur, &amp; Reinhold, 2017). Due to the long-term side effect of corticosteroid with the most common be cataracts, glaucoma, mild glucose intolerance, and cutaneous atrophy the lowest dose possible is the goal therapy with a gradual decreasing dose of 1-mg decrements (Arcangelo, Peterson, Wilbur, &amp; Reinhold, 2017).
The DMARD’s pharmacotherapy of patients with mild to moderate RA disease start with monotherapy of nonbiologic DMARD, usually hydroxychloroquine (Plaquenil), methotrexate (Rheumatrex, Trexall), leflunomide (Arava), or sulfasalazine (Azulfidine). A Plaquenil dose can be PO: 400-600 mg/day for 4-12 weeks, then 200-400 mg once daily (Adams, Holland, Bostwick, &amp; King, 2018). If the patient symptoms do not improve or worsened after three months of monotherapy, a second DMARD could be added to the regimen. Also, a third DMARD may be added for patients with persistent disease (Adams, Holland, Bostwick, &amp; King, 2018). The side effects watch for DMARD are mainly gastric irritation and stomatitis at worst DMARD cause hepatotoxicity with fibrosis and cirrhosis (McPhee, Papadakis, &amp; Rabow, 2017).  Also, biologic DMARD with effect to inhibit tumor necrosis factor (TNF) could be added if the patient is not responding to a synthetic DMARD (McPhee, Papadakis, &amp; Rabow, 2017). Thus, Enbrel could be a drug of choice at a dose of subcutaneous: 400 mg initially and at weeks 2 and 4, followed by 200 mg every other week (Adams, Holland, Bostwick, &amp; King, 2018).
RA Contributing factors
Patients with RA showed significantly higher rates of obesity thus showed a greater risk for disability (Colmegna, Hitchon, Bardales, Puri, &amp; Bartlett, 2016). In RA, a known aggravating factor is physical workloads such as the one caused of obesity, (Zeng, Klareskog, Alfredsson, &amp; Bengtsson, 2017). Physical workload increased the risk of developing both anticitrullinated protein antibody (ACPA) ACPA-positive and ACPA-negative RA (Zeng, Klareskog, Alfredsson, &amp; Bengtsson, 2017).  However, with the goal management of RA  to decrease joint damage and pain, there are needs to use a treatment such as anti-inflammatory medications, steroids and modifying anti-rheumatic drugs to decreases those symptoms (Huether, &amp; McCance, 2017). However, research showed that while managing the pain of patients with RA providers should closely monitor patient weight.  (Colmegna, Hitchon, Bardales, Puri, &amp; Bartlett, 2016). Steroids affect increasing patient weight. Thus, it is imperative that health professional help RA patients in managing weight for better treatment outcome.
Conclusion
The management of RA could be complex however providers should understand the mechanism of the disease and drug to the appropriate selection of treatment and prevention of the diseases.  Thus, in general RA’s treatment will consist of controlling and reducing joint inflammation. The disease modifying anti-rheumatic drugs help decrease joint damage (Huether, &amp; McCance, 2017). Also, anti-inflammatory medications and steroids help with the pain and inflammation (Huether, &amp; McCance, 2017). Therefore, providers must be diligent in educating patients on RA disease and their medication regimen along with their side effects. Also, providers should monitor for medications risk factor such as obesity to optimize patient’s treatment.

References
Adams, M., Holland, L. N., Bostwick, P. M., &amp; King, S. L. (2018). Pharmacology for nurses: A pathophysiological approach. Pearson Canada Incorporated.
Arcangelo, V. P., Peterson, A. M., Wilbur, V., &amp; Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams &amp; Wilkins.
Hammer, G. G. , &amp; McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.
Huether, S. E., &amp; McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO:Mosby
McPhee, S. J., Papadakis, M. A., &amp; Rabow, M. W. (Eds.). (2017). Current medical diagnosis &amp; treatment 2017. New York: McGraw-Hill Medical.
Zeng, P., Klareskog, L., Alfredsson, L., &amp; Bengtsson, C. (2017). Physical workload is associated with increased risk of rheumatoid arthritis: results from a Swedish population-based case-control study. RMD open, 3(1), e000324.. Retrieved from https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.

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