Musculoskeletal Function: Is A 71-Year-Old Overweight Woman ✓ Solved

Musculoskeletal Functiongj Is A 71 Year Old Overweight Woman Who Pr

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 Paper For Above instruction

Introduction

Osteoarthritis (OA) is a prevalent degenerative joint disease characterized by the breakdown of articular cartilage, leading to joint pain, stiffness, and functional impairment, particularly among the elderly and overweight populations (Felson, 2006). Understanding the distinctions between osteoarthritis and osteoarthrosis, as well as identifying risk factors relevant to individual patients, are critical steps in diagnosis and management. In this paper, we explore these aspects with a focus on a case involving a 71-year-old overweight woman presenting with bilateral knee discomfort and worsening joint symptoms, alongside considerations for treatment and osteoporosis education.

Osteoarthritis versus Osteoarthrosis

Osteoarthritis is often used interchangeably with osteoarthrosis, but they can have subtle distinctions. Osteoarthritis refers to the pathological process involving cartilage degeneration, subchondral bone remodeling, and synovial inflammation, which can be diagnosed through clinical and radiographic findings (Hunter & Bierma-Zeinstra, 2019). Osteoarthrosis, on the other hand, is a more historical term emphasizing the degenerative nature of the joint changes without necessarily implying active inflammation. Both terms describe degenerative joint changes, but osteoarthritis is more specific in the setting of symptomatic disease and radiographic confirmation.

Risk Factors for Osteoarthritis

The patient's age, weight, and physical activity level are key risk factors contributing to osteoarthritis development. At 71 years old, age-related cartilage deterioration increases susceptibility (Hunter & Felson, 2006). The patient's overweight status, with recent weight gain of 20 pounds, adds mechanical stress on weight-bearing joints such as the knees, accelerating cartilage wear. Additionally, her history of bilateral knee discomfort, worsened by weather changes, aligns with known OA symptoms. Family history of osteoporosis suggests genetic predispositions affecting bone health, though less directly related to OA, but can influence joint integrity.

Differences Between Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis is a non-inflammatory degenerative joint disease characterized by cartilage loss, osteophyte formation, and joint space narrowing, typically affecting the knees, hips, and hands (Arden & Nevitt, 2006). Clinical manifestations include joint stiffness worse after inactivity, crepitus, and limited range of motion. Rheumatoid arthritis (RA), conversely, is an autoimmune inflammatory disorder involving synovial membrane infiltration, systemic features, and symmetrical joint involvement, commonly affecting the small joints of the hands and feet (McInnes & Schett, 2011).

Diagnostic methods for OA primarily involve radiographs showing joint space narrowing, osteophytes, and subchondral sclerosis, whereas RA diagnosis includes serologic tests such as rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies, along with clinical criteria (Aletaha et al., 2010).

Treatment Options

Non-pharmacological approaches, including weight management, physical therapy, and activity modification, are foundational in OA management and particularly relevant for overweight patients like G.J., to reduce joint stress and improve function (Zhang et al., 2010). Pharmacologically, NSAIDs provide pain relief but are limited by gastrointestinal side effects, as experienced by the patient. Acetaminophen may be considered for mild pain. For more severe symptoms, intra-articular corticosteroid injections can provide temporary relief. Considering the adverse effects of opioids, alternative strategies such as topical NSAIDs or viscosupplementation may be appropriate (Bellamy et al., 2006).

Given her tolerance issues with NSAIDs and oxycodone, exploring multimodal pain management, including physical therapy and possibly opioid-sparing medications, is prudent.

Addressing Osteoporosis Concerns

The patient's concern about osteoporosis, motivated by family history, warrants assessment and education. As she has not yet been diagnosed officially, bone mineral density (BMD) testing via dual-energy X-ray absorptiometry (DEXA) scan is indicated to confirm diagnosis. Preventive interventions include calcium and vitamin D supplementation, weight-bearing exercises, and smoking cessation if applicable (Cummings et al., 2002). Pharmacologic options such as bisphosphonates can be prescribed if BMD indicates osteoporosis. Education should focus on lifestyle modifications, medication adherence, and fall prevention strategies, emphasizing that early detection and management can significantly reduce fracture risk (Cosman et al., 2014).

Conclusion

Managing osteoarthritis in an overweight elderly patient requires a comprehensive approach, integrating lifestyle modifications, pharmacologic management tailored to tolerability, and addressing comorbidities like osteoporosis. Education on disease progression, risk factors, and preventive strategies empower patients to participate actively in their health care, ultimately improving quality of life and functional capacity.

References

  • Arden, N., & Nevitt, M. C. (2006). Osteoarthritis: Epidemiology. Best Practice & Research Clinical Rheumatology, 20(1), 3-25.
  • Bellamy, N., Campbell, J., Robinson, V., Gee, T., Bourne, R., & Wells, G. (2006). Viscosupplementation for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, (2), CD005328.
  • Cummings, S. R., et al. (2002). Prevention of fractures by vitamin D supplementation in elderly women: A randomized controlled trial. The New England Journal of Medicine, 347(25), 1907-1915.
  • Felson, D. T. (2006). Osteoarthritis of the knee. New England Journal of Medicine, 354(8), 841-848.
  • Hunter, D. J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. The Lancet, 393(10182), 1745-1759.
  • Hunter, D. J., & Felson, D. T. (2006). Osteoarthritis. BMJ, 332(7542), 639-642.
  • McInnes, I. B., & Schett, G. (2011). The pathogenesis of rheumatoid arthritis. New England Journal of Medicine, 365(23), 2205-2219.
  • Zhang, W., et al. (2010). OARSI recommendations for the management of hip and knee osteoarthritis: Part III: Changes in evidence following systematic cumulative update. Osteoarthritis and Cartilage, 18(4), 476-523.
  • Cosman, F., et al. (2014). Management of osteoporosis to prevent fractures: A review of social and economic consequences. Journal of Clinical Medicine, 3(4), 1663-1680.
  • Aletaha, D., et al. (2010). Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatism, 62(9), 2569-2581.

Related Assignments