Musculoskeletal Function

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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.
Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.
Case Study Questions

Name the most common risks factors for Alzheimer’s disease
Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
Define and describe explicit and implicit memory.
Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
What would be the best therapeutic approach on C.J.

Sample Solution

Osteoarthritis vs. Osteoporosis:

  • Osteoarthritis: A degenerative joint disease caused by wear and tear of cartilage, leading to pain, stiffness, and swelling. Often affects weight-bearing joints like knees and hips. Risk factors include age, weight, joint injury, and repetitive stress.
  • Osteoporosis: A condition where bones lose density, increasing fracture risk. Nonclinical manifestations are absent in G.J.

Risk Factors for G.J.’s Osteoarthritis:

  • Age: 71 years, a known risk factor.
  • Weight: Recent weight gain of 20 pounds increases joint stress.
  • Family history: Suggests potential genetic predisposition.
  • Symptoms: Joint pain worsening with activity and improving with warmth, stiffness after inactivity, common in osteoarthritis.
  • Rheumatoid arthritis ruled out: No mention of symmetry, morning stiffness, or inflammatory markers.

Osteoarthritis vs. Rheumatoid Arthritis:

Feature Osteoarthritis Rheumatoid Arthritis
Cause Cartilage wear and tear Autoimmune disease
Symptoms Localized pain, stiffness Symmetrical pain, swelling, morning stiffness
Joints affected Weight-bearing joints (knees, hips) Small joints (hands, feet)
Diagnostic methods X-rays, physical exam Blood tests, X-rays, imaging

Treatment Options for G.J.:

Non-pharmacological:

  • Weight management: Crucial to reduce joint stress.
  • Exercise: Low-impact exercises like swimming or cycling to improve pain and mobility.
  • Physical therapy: To strengthen muscles and improve joint function.
  • Heat therapy: Can relieve pain and stiffness.

Pharmacological:

  • Acetaminophen: For mild pain relief.
  • Topical pain relievers: Creams or gels targeting specific joints.
  • Intra-articular injections: Hyaluronic acid or corticosteroids for temporary pain relief.
  • Consider alternative pain management: Opioids like oxycodone should be a last resort due to addiction risk.

Addressing Osteoporosis Concerns:

  • Bone density scan: To assess bone health.
  • Calcium and vitamin D supplementation: Crucial for bone health.
  • Lifestyle changes: Weight-bearing exercise, smoking cessation, limiting alcohol.
  • Bisphosphonates or other medications: To prevent bone loss if indicated by scan results.

Case Study 2: H.M.

Risk Factors for Alzheimer’s Disease:

  • Age: 67 years, increasing risk with age.
  • Family history: Unknown involvement, requires clarification.

Dementia Types:

Dementia Type Similarities Differences
Alzheimer’s Disease Memory loss, cognitive decline, personality changes Most common, plaques and tangles in brain
Vascular Dementia Cognitive decline, similar symptoms Caused by impaired blood flow to brain
Dementia with Lewy Bodies Memory loss, hallucinations, movement disorders Lewy bodies in brain
Frontotemporal Dementia Personality changes, language difficulties Affects frontal and temporal lobes

Explicit vs. Implicit Memory:

  • Explicit memory: Conscious recall of information (facts, events).
  • Implicit memory: Unconsciously learned skills and habits.

Alzheimer’s Disease Diagnosis Criteria:

  • National Institute of Aging and Alzheimer’s Association (NIA-AA) criteria consider cognitive decline, functional impairment, biomarkers, and neuropathology.

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