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 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.
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Osteoarthrosis is often used interchangeably with osteoarthritis, particularly in older literature. However, some distinctions are made:
- Osteoarthrosis may be considered the earlier stage or the underlying pathological process of cartilage degeneration and joint changes, even before significant symptoms develop. It emphasizes the biological and mechanical aspects of joint degradation.
- Osteoarthritis typically refers to the clinical manifestation of osteoarthrosis, meaning the patient is experiencing symptoms such as pain, stiffness, and functional limitations due to these joint changes.
In modern usage, the terms are largely synonymous, with osteoarthritis being the more commonly used term to describe the condition when symptoms are present.
List and Analyze the Risk Factors Presented in the Case that Contribute to the Diagnosis of Osteoarthritis:
- Age (71 years old): Age is the strongest risk factor for osteoarthritis. Over time, the cartilage in joints can naturally wear down.
- Analysis: G.J.'s age significantly increases her likelihood of having osteoarthritis due to the cumulative wear and tear on her knee and back joints over her lifetime.
- Overweight Status: Being overweight or obese puts excess stress on weight-bearing joints like the knees and hips, accelerating cartilage breakdown.
- Analysis: G.J.'s overweight status contributes directly to increased mechanical stress on her knees, exacerbating the degenerative process and pain. The recent 20-pound weight gain in the past nine months likely played a significant role in the worsening of her knee pain.
- History of Bilateral Knee Discomfort Worsened by Weather (Rain): While the exact mechanism is not fully understood, many individuals with osteoarthritis report increased joint pain in damp or rainy weather, possibly due to changes in barometric pressure affecting joint fluid and nerve sensitivity.
- Analysis: This symptom is a common anecdotal report among OA patients and supports the likelihood of the diagnosis.
- Discomfort in the Left Knee Greater than the Right Knee: This asymmetrical presentation is common in osteoarthritis, reflecting variations in joint use, minor injuries, or pre-existing wear.
- Analysis: This localized difference in pain intensity further points towards a degenerative joint process rather than a systemic inflammatory condition.
- History of Low Back Pain: Osteoarthritis can affect various joints, and the presence of long-standing low back pain suggests a broader predisposition to degenerative joint changes in weight-bearing areas.
- Analysis: This co-occurrence supports the likelihood of a generalized osteoarthritis process affecting multiple joints.
- Joint Stiffness After Inactivity ("Loosen Up" with Activity): Morning stiffness or stiffness after periods of rest that improves with movement is a classic symptom of osteoarthritis, often lasting less than 30 minutes.
- Analysis: G.J.'s report of stiffness after sitting or lying down that improves with activity is a key clinical manifestation consistent with osteoarthritis.
- Lack of Improvement with NSAIDs (Due to Stomach Discomfort): While NSAIDs can provide pain relief in OA, their side effects, particularly gastrointestinal issues, are common, especially in older adults. The limited relief and intolerance reported by G.J. do not rule out OA but highlight the challenges in managing her pain pharmacologically.
- Analysis: This indicates the need for alternative pain management strategies beyond standard NSAIDs.
- Alleviation of Pain with Oxycodone (Short-Term): Opioids can provide pain relief for severe OA pain, but their use is generally reserved for cases where other treatments have failed due to the risks of tolerance, dependence, and other side effects, as seen in G.J.'s case.
- Analysis: While providing relief, the increasing tolerance and request for higher doses are red flags for opioid misuse and highlight the need for safer, long-term pain management.
- Reduced Exercise Due to Worsening Arthritis: The cycle of pain leading to decreased activity, which in turn can worsen joint stiffness and overall health, is common in osteoarthritis.
- Analysis: This inactivity can contribute to muscle weakness around the joints, further destabilizing them and increasing pain.
Specify the Main Differences Between Osteoarthritis and Rheumatoid Arthritis:
| Feature | Osteoarthritis (OA) | Rheumatoid Arthritis (RA) |
|---|---|---|
| Nature of Disease | Degenerative, "wear and tear" of cartilage | Autoimmune, chronic inflammatory disease |
| Cause | Primarily mechanical stress, aging, genetics, injury | Immune system mistakenly attacks the synovium (joint lining) |
| Onset | Gradual, often worsens over many years | Can be insidious or more rapid, often with systemic symptoms |
| Age of Onset | Typically later in life (after 50), but can occur earlier | Can occur at any age, often between 30 and 50 |
| Stiffness | Morning stiffness usually lasts less than 30 minutes, stiffness after inactivity that improves with movement | Morning stiffness typically lasts longer than 30 minutes, often hours |
| Pain | Worse with activity, relieved by rest (initially) | Present even at rest, often improves with mild movement |
| Inflammation | Primarily localized to affected joints, mild | Systemic inflammation affecting multiple joints, often significant |
| Joint Involvement | Typically affects weight-bearing joints (knees, hips), hands (DIP, PIP, base of thumb), spine; often asymmetrical | Typically affects smaller joints first (hands: MCP, PIP; feet), usually symmetrical involvement |
| Systemic Symptoms | Usually absent | Common: fatigue, fever, weight loss, malaise |
| Joint Characteristics | Hard, bony swelling (osteophytes), crepitus (grinding) | Soft, spongy swelling due to synovitis, warmth, redness |
G.J.'s Case Study: Osteoarthritis
Define Osteoarthritis and Explain the Differences with Osteoarthrosis:
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Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of cartilage, the tissue that cushions the ends of bones within
1 a joint. This cartilage loss leads to bone-on-bone friction, causing pain, stiffness, and swelling. OA is often accompanied by other joint changes, including bone spurs (osteophytes) and thickening of the joint capsule. It is considered a disease process with both structural and symptomatic components.