Patient Diagnosis Case Study-Pain and Musculoskeletal Conditions

Patient Diagnosis Case Study-Pain and Musculoskeletal Conditions

Do you need help in a case study assignment?

Based on the knowledge you have gained up to this point, it is time to apply your skills to complete a case study for a patient presenting with pain.

Read the patient scenario and answer the following questions. Be sure to reference evidence-based guidelines and scholarly articles that are pertinent which may include UpToDate.

Scenario

Your patient presents at your clinic today with a chief complaint of bilateral knee pain. He is unemployed and has state-funded health insurance.

63-year-old Native American male, BMI 32, BP: 144/88, Pulse 80, O₂ 99% RA

Physical Exam: Negative except for tenderness over bilateral knee pain with mild swelling and pain on ROM. No evidence of instability in the joint.

Review of Systems: POS for bilateral knee pain

Imaging: X-ray done 1 month ago indicates “severe bilateral knee joint space narrowing in all compartments” noted with osteophytes

Past Medical Hx: seasonal allergies

Past Surgical Hx: none

Depression Screen: negative

Medications: naproxen, Excedrin prn

Social: married, lives in two-story home with bathroom and bedroom on the second floor; denies smoking, occasional alcohol use, denies current drug use (hx unknown)

Upon being interviewed, the patient reports a long history of chronic pain, mostly in his knees. Both knees seem to have recently worsened and now is 4/10 on the pain scale consistently. His pain seems to be worse with any activity. It does not seem to radiate. He tried icing it and taking Tylenol with little relief and admits taking Ibuprofen occasionally when he “can’t take it anymore.” He reports morning stiffness, but this improves quickly once he gets moving. His worst symptom is pain.

Based on the scenario provided, fully inform your patient and explain their diagnosis.

Respond to the questions below in 700- to 1050 words.

Use UpToDate, located in the University Library, to search for and locate the most current evidence-based guidelines to answer the following questions.

Overall Health and Pathophysiology

From a pathophysiological perspective, explain osteoarthritis (OA) versus rheumatoid arthritis (RA) in detail. Use 3 evidence-based resources to support your answer.

Although osteoarthritis (OA) and rheumatoid arthritis (RA) are the major types of arthritis, both differ based on their pathophysiological mechanisms. On the one hand, OA is a degenerative disease that affects the entire joint, including joint tissue (Jang et al., 2021). OA develops due to interacting risk factors such as mechanical stress, genetics, joint injury, overweight, and obesity. The interplay between these factors causes subchondral bone lesions, leading to focal erosions and articular cartilage degeneration (Coaccioli et al., 2022). The cartilage erosion causes it to deteriorate and thin with time, eventually reaching the bone and the entire surface of joint bones. Genetic changes affecting the hypertrophic chondrocyte occur in some cases, leading to osteophytes and bone thickening. Although inflammation and autoimmune processes are not much considered as a part of OA pathophysiology, recent evidence identifies immunological mechanisms that drive inflammation and tissue destruction to contribute to the development of osteoarthritis (Coaccioli et al., 2022). These changes result in joint swelling and stiffness, with the patient experiencing pain (Jang et al., 2021).

On the other hand, RA is an autoimmune disease or an inflammatory condition that develops due to chronic inflammation of the synovium due to the body’s immune system attacking healthy synovial joint tissue. It develops due to an interplay between epigenetic factors and environmental factors, causing modifications in certain proteins that the immune system fails to recognize (Radu & Bungau, 2021). Besides such environment-aided epigenetic modifications, some infections affecting joints may trigger an autoimmune response, leading to joint inflammation causing joint tissue damage (Damerau & Gaber, 2020). The result is damage to the joint, causing pain and swelling.

Is the diagnosis OA or RA? Explain your answer.

The diagnosis of the 63-year-old Native American male presented in the scenario is osteoarthritis (OA). There are a number of facts that lead to the development of this diagnosis. Firstly, the patient is a 63-year-old man. OA symptoms are slow to manifest and only worsen over time. If the case were rheumatoid arthritis, the patient would have experienced the symptoms, including pain, from an earlier age. Secondly, the patient is 63 years old: this age, due to prolonged use of the joints, increases the occurrence of OA. The patient also has a BMI of 32. This exerts a lot of mechanical stress on the joints, leading to cartilage erosion. This is a major indicator of OA. The patient also notes that pain and stiffness improve with movement, which is notable in patients with OA. Additionally, the X-ray results show a “severe bilateral knee joint space narrowing in all compartments” with osteophytes. These presentations indicate a potential loss of cartilage and a misaligned knee compartment, which are manifestations of early knee osteoarthritis.

Based on your diagnosis, and taking into consideration 1) cultural, 2) language, 3) health literacy, 4) and socioeconomic factors, how would you educate your patient on his diagnosis?

Providing effective education to the patient will require an approach that is both culturally competent and sensitive to their level of education and socioeconomic status. This means considering the patient’s culture in relation to the OA and bone and body issues, the language used, health literacy, and socioeconomic factors. In the case of the 63-year-old Native American man, educating him about his diagnosis will first focus on understanding how his culture perceives conditions such as OA before providing treatment. In this case, diagnosis education will seek to address the specific cultural concerns that enable the patient to understand their condition best. The language choice will also be based on the language the patient fully understands. If the patient cannot communicate in English, an interpreter will be used. Thirdly, a consideration of how much the patient knows about arthritis and specific types of arthritis will help guide the selection of what to cover, the nature of words used, and if there is a need to use visual aids when educating the patient. Since the patient is unemployed and has state-funded health insurance, it is best to educate him about his diagnosis and avoid mentioning certain costs that may affect how the patient seeks care services. Therefore, when educating the patient about their diagnosis, it is best to provide care options that are affordable to the patient.

What are possible preventions and interventions relating to the diagnosis?

Various possible preventions and interventions can be implemented to help the 63-year-old man manage his condition. One major intervention to prevent OA-related complications is for the patient to lose weight and maintain a BMI below 27. This will help reduce pressure on his joints, especially the knees. Due to his age, the patient also requires physical therapy. Physical therapy, such as massage, especially on the joints, can help ease stiffness and pain and improve the strength and function of the joints. Supporting equipment such as braces can be used to help the patient. In case the OA is complicated, surgery is recommended. Additionally, the patient must be provided with medications to manage the pain.

 References

Coaccioli, S., Sarzi-Puttini, P., Zis, P., Rinonapoli, G., & Varrassi, G. (2022). Osteoarthritis: New insight on its pathophysiology. Journal of Clinical Medicine 2022, Vol. 11, Page 6013, 11(20), 6013. https://doi.org/10.3390/JCM11206013

Damerau, A., & Gaber, T. (2020). Modeling rheumatoid arthritis in vitro: From experimental feasibility to physiological proximity. International Journal of Molecular Sciences, 21(21), 1–25. https://doi.org/10.3390/IJMS21217916

Jang, S., Lee, K., & Ju, J. H. (2021). Recent updates on diagnosis, pathophysiology, and treatment for osteoarthritis of the knee. International Journal of Molecular Sciences 2021, Vol. 22, Page 2619, 22(5), 2619. https://doi.org/10.3390/IJMS22052619

Radu, A. F., & Bungau, S. G. (2021). Management of rheumatoid arthritis: An overview. Cells 2021, Vol. 10, Page 2857, 10(11), 2857. https://doi.org/10.3390/

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Exam Content
Based on the knowledge you have gained up to this point, it is time to apply your skills to complete a case study for a patient presenting with a recurring headache.

Complete the Patient Diagnosis Case Study: Pain and Musculoskeletal Conditions document.
Use the following resources to help you with the assessment:
AccessMedicine in the University Library
UpToDate in the University Library
Medscape
National Institute of Neurological Disorders and Stroke
Centers for Disease Control: Opioids
Arizona Department of Health: Opioid Epidemic
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Format your citations according to APA guidelines.