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 Questions
- Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.
- Specify the main differences between osteoarthritis and rheumatoid arthritis, 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 concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.
Submission Instructions:
- APA style writing
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources (within 5 years). Your initial post is worth 8 points.
1. Osteoarthritis vs. Osteoarthrosis:
Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of cartilage in the joints leading to pain, stiffness, and decreased mobility. It is the most common form of arthritis and typically affects weight-bearing joints such as the knees, hips, and spine. Risk factors for OA include age, obesity, joint injury, genetics, and joint overuse.
On the other hand, osteoarthrosis is a term often used interchangeably with osteoarthritis, but it more specifically refers to the degenerative process affecting the articular cartilage of joints. It is essentially synonymous with osteoarthritis but may imply a more general process of joint degeneration rather than a specific disease entity.
In G.J.’s case, the presentation of bilateral knee discomfort worsened by rainy weather, stiffness after periods of inactivity, and improvement with activity are classic symptoms of osteoarthritis. The exacerbation of symptoms after gaining weight further supports this diagnosis, as obesity is a significant risk factor for OA. Additionally, the family history of joint diseases and the patient’s advanced age contribute to her likelihood of developing OA.
2. Osteoarthritis vs. Rheumatoid Arthritis:
Osteoarthritis (OA) primarily affects the articular cartilage of joints and is characterized by pain, stiffness, and decreased mobility. It typically involves weight-bearing joints and progresses slowly over time. Radiographic findings in OA include joint space narrowing, osteophyte formation, and subchondral sclerosis.
In contrast, rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of the synovium, leading to joint swelling, pain, and eventual joint deformity. RA commonly affects small joints such as those in the hands and feet and is associated with systemic symptoms like fatigue and fever. Radiographic findings in RA may include joint erosion, periarticular osteopenia, and soft tissue swelling.
Diagnostic methods for OA include clinical evaluation, imaging studies (X-rays, MRI), and laboratory tests to rule out other conditions. Treatment for OA typically involves a combination of non-pharmacological interventions such as weight management, physical therapy, and assistive devices, along with pharmacological options like NSAIDs, acetaminophen, and intra-articular corticosteroid injections.
3. Treatment Alternatives for G.J.:
Given G.J.’s intolerance to NSAIDs due to gastrointestinal discomfort and her increasing tolerance to oxycodone, it’s important to explore alternative treatment options. Non-pharmacological interventions such as weight loss through diet and exercise can help reduce the load on her joints and alleviate symptoms. Physical therapy can improve strength and flexibility, while assistive devices like braces or canes can provide support.
Pharmacological options may include acetaminophen for pain relief, tramadol for moderate to severe pain, or topical NSAIDs to minimize systemic side effects. Intra-articular injections of corticosteroids or hyaluronic acid can provide localized relief. Additionally, lifestyle modifications such as low-impact exercise and heat/cold therapy may help manage symptoms.
4. Addressing Osteoporosis Concerns:
To address G.J.’s concerns about osteoporosis, I would recommend bone density testing (DEXA scan) to assess her risk. Education regarding osteoporosis prevention strategies, including adequate calcium and vitamin D intake, weight-bearing exercise, smoking cessation, and fall prevention measures, would be provided. Medications such as bisphosphonates may be considered based on her bone density results and fracture risk assessment. Regular follow-up and monitoring of bone health would be emphasized as part of her overall care plan.
In conclusion, G.J.’s presentation is consistent with osteoarthritis, and a comprehensive management approach involving both non-pharmacological and pharmacological interventions is warranted. Additionally, addressing her concerns about osteoporosis and providing appropriate education and interventions are essential components of her care plan.