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 hasnt 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.

 

Sample Solution

G.J.’s Case: Managing Knee Osteoarthritis and Patient Concerns

G.J.’s symptoms point towards osteoarthritis (OA), the most common form of arthritis, affecting primarily the joints in the knees and low back.

Osteoarthritis vs. Osteoarthrosis:

These terms are often used interchangeably. Osteoarthritis refers to the disease itself, while osteoarthrosis emphasizes the degenerative nature of the joint cartilage.

Risk Factors for G.J.’s Osteoarthritis:

  • Age: At 71, G.J. is within the age range where OA risk increases.
  • Weight: Recent weight gain puts additional stress on weight-bearing joints like knees and lower back.
  • Previous Joint Injury: While not mentioned, past knee injuries can increase OA risk.
  • Family History: A family history suggests a possible genetic predisposition.

Differences Between Osteoarthritis and Rheumatoid Arthritis (RA):

Feature Osteoarthritis (OA) Rheumatoid Arthritis (RA)
Cause Cartilage degeneration Autoimmune disease
Symptoms Pain, stiffness, reduced mobility Joint pain, swelling, morning stiffness, fatigue
Joints Affected Primarily weight-bearing joints (knees, hips) Any joint, often symmetrical involvement
Diagnosis X-rays, physical examination Blood tests, X-rays, physical exam

Treatment for G.J.’s OA:

Non-Pharmacological:

  • Weight Management: Weight loss can significantly reduce stress on joints and improve symptoms.
  • Exercise: Regular low-impact exercises like swimming or walking strengthen muscles and improve joint flexibility.
  • Physical Therapy: Therapeutic exercises and modalities can improve mobility and reduce pain.
  • Heat/Cold Therapy: Heat can loosen stiffness, while cold can reduce inflammation.
  • Assistive Devices: A cane or knee brace can provide support and reduce stress on the joints.

Pharmacological:

  • Over-the-counter pain relievers: Acetaminophen or topical pain relievers may offer relief. (Consider lower dose options due to previous stomach issues)
  • Prescription NSAIDs: If over-the-counter options are insufficient, discuss alternative NSAIDs with a lower risk of stomach problems.

Addressing G.J.’s Osteoporosis Concern:

  • Bone Density Scan: While nonclinical manifestations haven’t developed, a DEXA scan can assess bone density and identify potential osteoporosis.
  • Lifestyle Modifications: A healthy diet rich in calcium and vitamin D, along with weight-bearing exercises, promotes bone health.
  • Medication: If osteoporosis is diagnosed, discuss potential medications to increase bone density and reduce fracture risk.

Education for G.J.:

  • Explain the difference between OA and osteoporosis and their risk factors.
  • Emphasize the importance of weight management, exercise, and a healthy diet for both OA and bone health.
  • Discuss the benefits of non-pharmacological pain management strategies.
  • Provide information on support groups or educational resources on OA and osteoporosis management.

Oxycodone Dependence:

  • Address her concerns about pain management empathetically.
  • Discuss the limited effectiveness and risks of long-term opioid use.
  • Explore alternative pain management strategies together and guide her towards safer options.

Remember, this information provides a framework for managing G.J.’s case. A detailed evaluation and personalized treatment plan by a healthcare professional are crucial for optimal outcomes.

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