Osteoarthritic Disease, Case Study Example

Introduction

As a clinician, it is important and necessary to develop an effective protocol to address specific clinical cases and to determine how to best move forward with a successful diagnosis and treatment plan. It is important to address these findings through a detailed evaluation of a patient’s case so that treatment is optimized and is appropriate for the patient’s specific needs. The following discussion will address a case study involving osteoarthritis and will consider the different aspects of the condition, including clinical presentation and symptoms. An appropriate treatment plan will also be identified and supported by clinical evidence so that the patient’s condition begins to improve over time.

Osteoarthritis is a condition that is characterized by joint pain, particularly in the hip, knees, hands, and toes of middle age and elderly persons (American College of Rheumatology, 2012). It is the cause of the majority of disability problems and impacts approximately 27 million people in the United States alone (American College of Rheumatology, 2012). This condition is exacerbated by excess weight, genetic factors, and repetitive use of joints in a specific manner (American College of Rheumatology, 2012). Finally, osteoarthritis is not curable; however, it is treated with medication and exercises to improve mobility of the affected joints. (American College of Rheumatology, 2012). In some cases, surgery is warranted, but many factors must be addressed prior to making any decisions regarding surgical interventions (American College of Rheumatology, 2012).

Question 1: What other questions should you ask?

In addressing this patient, questions regarding her degree of pain on a scale of one to ten, and her level of mobility should also be considered. Is she able to move around quickly and without extreme difficulty, or is basic mobility a challenge? Is she currently taking any type of medication to ease the pain? If so, how frequently is it taken? The patient should also be asked regarding if there have been any other changes in her health status as well as changes in her weight and nutrition.

Question 2: What should you ask about the patient’s medical history?

In regards to the patient’s medical history, her history of pain should be addressed, as well as her recent weight gain due to lack of mobility and her limited strength. She should be asked regarding her stiffness and determine if it is similar to “inactivity stiffness”: “Inactivity stiffness in osteoarthritic lower limb joints lasts about 5 to 10 minutes and occurs when the patient gets up and bears weight after prolonged immobility” (Hasan and Shuckett, 2010). It is also important to address her prior horseback riding injury and why she stopped riding after landing on her hip, as well as her lower back pain, which has steadily worsened over time.

Question 3: What is the differential diagnosis?

In addressing differential diagnoses, the following conditions should be considered: 1) Inflammatory arthritis, which is characterized by joint pain in the wrists, ankles or shoulders; 2) Rheumatoid arthritis, which is characterized by severe joint inflammation; and 3) Periarticular pain known as bursitis or tendonitis (Johns Hopkins Arthritis Center, 2013). Each of these conditions represents a possible diagnosis for the female patient and should be considered when making the definitive diagnosis.

Question 4: What are the positive and negative examination findings?

Upon examination, the positive findings include her ability to move about, even if impaired; no history of fracture other than at the age of 9; back pain that has not worsened in recent months; remains active in the garden; she does not have any heat, swelling, or redness in joint areas, or numbness or tingling in her legs; she used to be active as a horseback rider; and her right side is more troublesome than her left. The negative examination findings include constant pain in the lower back; a 10-lb weight gain in recent months due to lower levels of activity; consistent joint stiffness; and general limited mobility on the right side of the body. Based upon the patient’s medical history, other negative findings include birth to nine children over nine separate pregnancies, which caused increased bodily strain due to the excess weight involved in having children along with the repeated strain of childbirth. In addition, her mother’s severe scoliosis is cause for concern because perhaps there is a genetic element to her condition that should not be ignored. Finally, she is hesitant to take any type of medication because of her sensitivity to possible side effects.

Question 5: What laboratory tests are required?

In order to accomplish the objectives in diagnosing the patient, the laboratory tests that are required include X-Rays and MRIs to determine if there are any visible injuries to joints and cartilage between bones in the areas where pain is prevalent (Mayo Clinic, 2013). These tests will also demonstrate if there are other factors to consider and if osteoarthritis is the appropriate diagnosis (Mayo Clinic, 2013). Furthermore, standard laboratory tests may include blood tests to determine if other factors are present to determine if the diagnosis is rheumatoid arthritis or another type of condition (Mayo Clinic, 2013). The joint fluid analysis is also used to obtain fluid from the joint and determine the cause of any inflammation, such as gout or another type of infection (Mayo Clinic, 2013).

Question 6: What results with the laboratory tests provide?

The selected laboratory tests will be used to determine if there is any evidence of joint, cartilage, or surrounding tissue damage in the areas where pain is prevalent (Mayo Clinic, 2013). In addition, selected laboratory tests will determine if there are other factors associated with a possible differential diagnosis and should be used to rule out other conditions (Mayo Clinic, 2013). It is important to perform these tests in the event that there is any doubt that osteoarthritis is the appropriate diagnosis.

Question 7: How should be patient be managed in the short term?

Over the short term, the patient in question should be provided with pharmacological treatments such as acetaminophen or NSAIDS to alleviate any pain and inflammation that is observed (Johns Hopkins Arthritis Center, 2013).However, there are risk factors associated with the use of NSAIDs on a long term basis, such as ulcers and bleeding; therefore, this type of treatment should be used in moderation and should be monitored accordingly (Johns Hopkins Arthritis Center, 2013). In addition to pharmacologic alternatives, it is known that “Exercise has also been shown to be safe and beneficial in the management of OA. It has been suggested that joint loading and mobilization are essential for articular integrity. In addition, quadricep weakness, which develops early in OA, may contribute independently to progressive articular damage. Several studies in older adults with symptomatic knee OA have shown consistent improvements in physical performance, pain and self-reported disability after 3 months of aerobic or resistance exercise” (Johns Hopkins Arthritis Center, 2013). Therefore, it is expected that additional forms of exercise in moderation will be effective in reducing the pain that the patient is experiencing, as well as the ability to reduce inflammation (Johns Hopkins Arthritis Center, 2013).

Question 8: How should the patient be managed over the long term?

The primary long-term objective for the patient in question should be to take the steps that are necessary to prevent any type of surgical intervention because a patient of her age faces higher risks with any type of invasive surgical procedure. In addition, the patient should continue a long-term exercise regimen and continue her gardening activities as much as possible to prevent further decline of the affected joints. It is important to address other options for this patient so that her quality of life remains relatively intact in spite of her condition and the joint pain that she is experiencing. It is perhaps most important to make all possible efforts to preserve the patient’s condition for as long as possible so that the patient is able to enjoy the later years of her life in a successful manner.

Conclusion

The example case study provides further evidence that the patient is experiencing osteoarthritis, thereby leading to a gradual decline in joint function and an increase in pain. It is important to evaluate, diagnose, and treat the patient as quickly as possible to prevent additional pain and joint decline. Therefore, the clinician and the patient’s family members should work collaboratively to discuss her condition and to take the steps that are necessary to produce effective outcomes to meet her needs over the long term. This is an essential component of her short and long term treatment plans so that the patient begins to experience relief from her chronic pain and joint stiffness that has gradually worsened over time. This is an important objective for the clinical team and the patient so that her osteoarthritis condition is improved over a period of time. This is also important in demonstrating the effectiveness of non-surgical techniques in order to improve her condition and her long-term prognosis in the least invasive manner possible.

References

American College of Rheumatology (2012). Osteoarthritis. Retrieved from http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/osteoarthritis.asp

Hasan, M., and Shuckett, R. (2010). Clinical features and pathogenetic mechanisms of osteoarthritis of the hip and knee. BC Medical Journal, 52(8), 393-398.

Johns Hopkins Arthritis Center (2013). Osteoarthritis: differential diagnosis.

Johns Hopkins Arthritis Center (2013). Osteoarthritis: treatment.

Mayo Clinic (2013). Tests and diagnosis. Retrieved from http://www.mayoclinic.com/health/osteoarthritis/DS00019/DSECTION=tests-and-diagnosis