analyze a patient with progressive joint pain and functional decline. Using
advanced pathophysiology concepts, you will compare rheumatoid arthritis (RA) and osteoarthritis (OA),
determine the most likely diagnosis, and support your conclusions with primary, evidence-based
literature.
Length Requirement (per rubric): The body of the paper must be no more than 2 pages, excluding title
page and references.
Format: APA 7th edition with MSN Template
Sources: Minimum of 3 current, peer-reviewed primary sources
Case Scenario
Patient Case Scenario
Patient: Mrs. Eleanor R.
Age: 66 years
Sex: Female
Mrs. Eleanor R. is a 66-year-old Caucasian female, retired elementary school teacher who presents with
progressively worsening joint pain, stiffness, and functional decline over the past five years, with a
notable acceleration in symptoms during the last 12 months.
She reports waking each morning with severe stiffness lasting 1–2 hours, describing her hands as feeling
“locked and swollen” until she runs them under warm water. She notes bilateral pain and swelling in her
hands, wrists, and knees, with intermittent redness and warmth. By mid-afternoon, she experiences
profound fatigue and difficulty gripping objects, often dropping items such as coffee cups or keys.
Mrs. R. states she was initially told by a previous provider that she had “age-related arthritis,” but she
feels her symptoms are worsening rather than stabilizing. She reports increasing difficulty with fine motor
tasks, including buttoning clothes and opening jars, and recently stopped gardening due to pain and hand
weakness.
Lifestyle & Self-Directed Interventions
Page 1 of 4Mrs. R. describes her diet as “not great,” consisting largely of processed foods and minimal fresh protein
or omega-3 intake. She is, however, highly committed to self-care interventions, stating:
“I may not eat perfectly, but I never miss my vitamins.”
She takes vitamin D, vitamin C, magnesium, and turmeric daily. Six months ago, after reading online
testimonials, she independently began hyperbaric oxygen therapy (HBOT) at a private wellness center,
completing multiple sessions weekly. She reports partial pain relief, but persistent stiffness, swelling, and
progressive hand deformity.
Medical History
• Hypertension, well controlled
• Obesity (BMI 32)
• Former smoker (20 pack-year history; quit 10 years ago)
Family History:
• Mother with “crippling arthritis” requiring early hand surgery
• Sister with an autoimmune condition requiring long-term immunologic treatment
Mrs. R. expresses frustration and concern, stating:
“I’m doing everything I can, but I feel like my joints are getting worse instead of better.”
Clinical Considerations for Analysis
At today’s visit, the provider notes visible swelling of the MCP and PIP joints bilaterally, reduced grip
strength, and difficulty rising from a seated position due to knee stiffness. No prior inflammatory markers
or autoimmune laboratory testing have been performed.
Page 2 of 4CASE STUDY QUESTIONS (RUBRIC-ALIGNED) – Thoughts to consider in your writings for the
content – however, follow the entire rubric.
Rubric Criterion 1 – Primary Pathophysiological Processes (30 points)
Rubric language:
“Develop a case study analysis examining patient signs and symptoms. Discuss the primary
pathophysiological processes and their significance for symptom development and diagnosis”
Question 1: Pathophysiology and Diagnosis
1. Describe the primary pathophysiological mechanisms of:
o Rheumatoid arthritis (RA)
o Osteoarthritis (OA)
2. Using the patient’s clinical presentation, explain how these mechanisms account for:
o Prolonged morning stiffness
o Symmetrical joint involvement
o Pain, swelling, and functional impairment
3. Based on the patient’s signs and symptoms, identify the most likely diagnosis and provide a
clear, brief, evidence-based rationale.
Rubric Criterion 2 – Genetics and Risk Factors (30 points)
Rubric language:
“Describe the role genetic mutations play in the development of the disease and the risk factors that make
the patient more susceptible”
Question 2: Genetics and Disease Susceptibility
1. 2. 3. Discuss the role of genetic predisposition in the development of rheumatoid arthritis.
Compare this genetic contribution to osteoarthritis.
Identify and explain patient-specific risk factors that increase susceptibility to the most likely
diagnosis.
Rubric Criterion 3 – Racial/Ethnic Variables AND History/Lifestyle Factors (25 points total)
Rubric language:
“Explain any racial/ethnic variables that may impact physiological functioning AND explain factors in
the patient’s history and lifestyle that could have contributed to the development of the disease process”