Musculoskeletal Function: G.J. Is A 71-Year-Old Overweight W

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

G.J., a 71-year-old woman, presents with a longstanding history of bilateral knee discomfort exacerbated by weather changes and improved by warmth and dry conditions. Her symptoms have persisted despite previous NSAID use and temporary relief with opioids, which she gradually requires at higher doses. She reports stiffness after inactivity, such as sitting or lying for extended periods, and recent weight gain has intensified her joint pain. Additionally, she suffers from chronic low back pain that has worsened over recent months, and she experiences difficulty navigating stairs at home. Her concerns about osteoporosis are driven by family history, albeit she has not yet demonstrated clinical signs. This case involves assessing osteoarthritis (OA), understanding risk factors, differentiating from other joint disorders, reviewing treatment options, and addressing osteoporosis concerns.

Define osteoarthritis and explain the differences with osteoarthrosis

Osteoarthritis (OA) is a degenerative joint disease characterized by cartilage deterioration, subchondral bone sclerosis, osteophyte formation, and joint space narrowing, leading to pain, stiffness, and decreased mobility (Hsieh et al., 2020). It primarily affects weight-bearing joints such as the knees, hips, and the hands. Conversely, osteoarthrosis is an older term often used interchangeably with OA, but it more specifically describes the radiographic and degenerative changes in joints without necessarily implying symptomatic disease. Essentially, osteoarthrosis refers to the morphological alterations seen on imaging, while OA encompasses the clinical syndrome including symptoms and functional limitations (Felson et al., 2019). Consequently, all OA involves osteoarthrosis, but osteoarthrosis may or may not be symptomatic.

List and analyze the risk factors that contribute to the diagnosis of osteoarthritis in this case

Several risk factors are evident in this case, both intrinsic and extrinsic. G.J.’s age is a primary risk factor, as prevalence increases with advancing age due to cartilage degeneration and diminished regenerative capacity (Dai et al., 2021). Excess weight, especially the recent 20-pound gain, significantly contributes, as increased body mass exerts additional mechanical stress on the knee joints, accelerating cartilage breakdown. Her history of bilateral symptoms suggests systemic or genetic predisposition, compounded by possible sedentary lifestyle contributing to joint stiffness and decreased muscle support. Family history of osteoporosis may hint at genetic susceptibility to degenerative joint diseases. Additionally, her comorbid low back pain might reflect systemic degenerative processes affecting the musculoskeletal system. Environmental factors, such as weather changes, are also known to influence symptoms, possibly through alterations in joint pressure and inflammation (Zhang et al., 2019).

Specify the differences between osteoarthritis and rheumatoid arthritis

Osteoarthritis (OA) and rheumatoid arthritis (RA) differ notably in etiology, clinical presentation, joints involved, and diagnostic features. OA is a non-inflammatory, degenerative joint disease predominantly affecting the cartilage and subchondral bone, with symptoms such as joint pain that worsens with activity and stiffness lasting less than 30 minutes post-inactivity, mainly affecting weight-bearing joints (Zhao et al., 2020). In contrast, RA is an autoimmune, systemic inflammatory disorder characterized by synovial membrane inflammation, symmetric joint swelling, pain, and morning stiffness lasting more than an hour. RA typically involves small joints like the knuckles and wrists symmetrically, with elevated inflammatory markers and positive serology such as rheumatoid factor or anti-CCP antibodies (Rojas et al., 2022). Diagnostic methods for OA include radiographs showing joint space narrowing and osteophytes, whereas RA diagnosis involves serologic tests, imaging showing synovitis, and clinical criteria per ACR guidelines.

Describe treatment options — non-pharmacological and pharmacological — suitable for G.J. and rationale

The management of G.J.’s osteoarthritis should employ both non-pharmacological and pharmacological strategies tailored to her needs and comorbidities. Non-pharmacological approaches include weight management to reduce joint load, physical therapy emphasizing strengthening exercises and range-of-motion activities, and patient education on joint protection techniques (Bennell et al., 2021). Cognitive-behavioral therapy may help address chronic pain and improve coping skills. Additionally, assistive devices such as braces or canes can aid mobility and reduce joint stress.

Pharmacologically, first-line treatments include topical NSAIDs to manage localized pain with minimal systemic effects. Considering her intolerance to NSAIDs, acetaminophen may be used for mild pain control. For more severe pain, intra-articular corticosteroid injections can provide short-term relief. Given her history of opioid use and increasing tolerance, non-opioid analgesics are preferred, with opioids reserved for refractory cases under strict monitoring. Pharmacologic management must also include addressing her weight and physical activity to slow progression. For her comorbid conditions, such as hypertension, care should involve ensuring medications are compatible and not exacerbating her joint disease.

Handling concerns about osteoporosis: interventions and education

Her concern regarding osteoporosis necessitates proactive assessment and education. First, bone mineral density (BMD) testing via dual-energy X-ray absorptiometry (DXA) should be performed to establish baseline status. If osteoporosis is confirmed, risk reduction strategies include adequate calcium (1,200 mg daily) and vitamin D supplementation, physical activity emphasizing weight-bearing exercises, and lifestyle modifications such as smoking cessation and limiting alcohol intake (Khosla et al., 2020). Pharmacologic treatment options include bisphosphonates, denosumab, or selective estrogen receptor modulators for patients with confirmed osteoporosis or high fracture risk. I would educate her about the importance of medication adherence, nutritional support, and fall prevention strategies, including home safety assessments. Regular follow-up is essential to monitor treatment efficacy and adherence, alongside ongoing lifestyle counseling.

References

• Bennell, K., Hunter, D. J., & Hinman, R. S. (2021). Osteoarthritis. The Lancet, 397(10289), 2112-2125.
• Dai, L., et al. (2021). Aging and osteoarthritis: Pathogenesis and pharmacologic therapy. Aging & Disease, 12(2), 366-377.
• Felson, D. T., et al. (2019). Osteoarthritis: New insights. Current Rheumatology Reports, 21(2), 7.
• Hsieh, P. C., et al. (2020). Pathogenesis and management of osteoarthritis. Nature Reviews Rheumatology, 16(2), 69-89.
• Khosla, S., et al. (2020). Osteoporosis. The Lancet, 395(10227), 177-189.
• Rojas, M., et al. (2022). Rheumatoid arthritis: Pathophysiology, diagnosis, and management. BMJ, 377, e068979.
• Zhang, W., et al. (2019). Effect of weather on osteoarthritis symptoms. Arthritis Care & Research, 71(1), 113–122.
• Zhao, J., et al. (2020). Clinical differences between osteoarthritis and rheumatoid arthritis. Clinical Rheumatology, 39(4), 1287-1294.