Musculoskeletal Function:
G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.
Case Study 1 Questions:
- Define osteoarthritis and explain the differences with osteoarthrosis.
- List and analyze the risk factors that are presented in the case that contribute to the diagnosis of osteoarthritis.
- Specify the main differences between osteoarthritis and rheumatoid arthritis, and make sure to include clinical manifestations, major characteristics, joints usually affected, and diagnostic methods.
- Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.
- How would you handle the patient’s concern about osteoporosis? Describe the interventions and education you would provide to her regarding osteoporosis.
- Osteoarthritis is a degenerative joint disease characterized by the breakdown and loss of cartilage in the joints, leading to pain, stiffness, and decreased mobility. Osteoarthrosis, on the other hand, is a term used to describe joint degeneration due to a variety of causes, such as aging, trauma, and metabolic disorders.
- Risk factors that contribute to the development of osteoarthritis in this case include: advanced age, obesity, a history of joint injury, and a family history of the disease.
- Osteoarthritis and rheumatoid arthritis are two different types of arthritis. Osteoarthritis is a degenerative joint disease that usually affects weight-bearing joints such as the knees, hips, and spine. The onset is gradual, and the symptoms tend to worsen over time. Rheumatoid arthritis, on the other hand, is an autoimmune disorder that affects the lining of the joints, causing inflammation, pain, and swelling. It typically affects the small joints of the hands and feet and can progress rapidly. Diagnostic methods for osteoarthritis include X-rays, physical examination, and joint fluid analysis. Diagnostic methods for rheumatoid arthritis include blood tests and imaging studies such as X-rays and MRI.
- Treatment options for osteoarthritis include both non-pharmacological and pharmacological interventions. Non-pharmacological interventions include weight loss, exercise, physical therapy, and the use of assistive devices such as canes and braces. Pharmacological interventions include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids. For this patient, weight loss and physical therapy would be appropriate non-pharmacological interventions, given her obesity and difficulty with stairs. In terms of pharmacological interventions, acetaminophen or an NSAID with gastroprotective agents would be a good first-line option for pain management. Opioids should be reserved for severe cases where other treatments have failed or when pain is not well-controlled.
- To address the patient’s concern about osteoporosis, I would first assess her current risk factors, including age, gender, and family history. I would also order a bone density scan to determine if she has osteoporosis or if she is at risk for the disease. If she is found to have osteoporosis or be at risk, I would recommend calcium and vitamin D supplementation, weight-bearing exercise, and fall prevention strategies. I would also discuss with her the importance of avoiding tobacco and excessive alcohol consumption, both of which increase the risk of osteoporosis.