Case Study #1 Osteoarthritis Patients Chief Complaint: I’m having difficulty walking, my joints have been killing me for the past 3 months. My knees and lower back hurts. History of Present Illness: B. is a 71 yo overweight male who presents to your clinic for the first time complaining of months to years of bilateral knee pain that becomes worse with rain and feels better when the weather is warm and dry. He is now concerned because the arthritis symptoms have not an improved this summer. The pain in the right knee is greater than the left knee. He is also concerned about back pain he has had for several years that has recently become worse. He has difficulty using the stairs in his home. The patient has recently visited an orthopedic provider who treated him with a variety of NSAIDs to help control the pain. The medication did provide mild relief, but also caused a lot of G.I. upset, nausea and stomach pain. The pain has previously been relieved with oxycodone, but he did requir

Osteoarthritis Case Analysis

The Disease Process and Its Significance Across the Lifespan

Osteoarthritis is a degenerative joint condition linked to the degradation of joint structures (Mahmoudian et al., 2021). It is the most common form of arthritis and occurs more often in older adults. Usually, osteoarthritis patients report joint pain along with a few seconds of stiffness in the morning or after periods of inactivity. This results from the cartilage degeneration that cushions the ends of bones (Norris, 2019).

Although osteoarthritis can affect any joint, it is most commonly found in the hands, spine, knees, and hips. The symptoms of the disease occur slowly and worsen as time goes on. One of the main symptoms of the disease is pain in the joints because of joint injury during or after movement. Another symptom is joint stiffness after being inactive for a long time or awakened. Other symptoms include grating sensation, swelling of the affected joint, loss of flexibility, bone spurs, and tenderness (Mahmoudian et al., 2021).

The disease negatively impacts the life of the affected individual. People with the disease often have limited movement and lose independence to engage in activities such as bathing, walking, and going to work (Mahmoudian et al., 2021). The pain caused by the disease is also severe and can negatively impact the quality of life of a patient. The patient’s financial status can be impacted negatively, especially in the case of severe OA that needs surgery.

Pathophysiology of Osteoarthritis

The pathophysiology of osteoarthritis is multifaceted and intertwined. Three primary processes characterize the pathophysiology of OA: joint inflammation, structural degradation, and mechanical wear and tear (Khlopas et al., 2019). Though aging and overuse are assumed to be the primary reasons for this process, higher levels of different cytokines and chemokines in the synovium of the affected joints also reveal a sign of an inflammatory course (Khlopas et al., 2019).

Matrix metalloproteinases are triggered, and the cartilage extracellular matrix is broken down. According to Khlopas et al. (2019), cartilage strain indirectly induces chondrocyte activation, proliferation and subsequently the synthesis of degrading enzymes. Chondrocytes later undergo apoptosis; this results in an overall decrease in cell numbers (Khlopas et al., 2019). The first anatomical stage of osteoarthritis is articular cartilage degradation, which comprises surface fibrillation, irregularity and isolated erosions.

Injury to the cartilage may stimulate chondrocyte division, and their offspring may hypertrophy into osteophytes or bone spurs (Khlopas et al., 2019). Subchondral bone sclerosis, as well as the formation of bone cysts at a later stage, can aggravate joint pain and stiffness (Khlopas et al., 2019). The advanced disease leads to episodic synovitis. Bony erosions are uncommon, but they occur in erosive OA.

History and Physical Findings Related to the Disease

A lot of history findings are related to OA in the case. One of the historical findings is that he has had problems walking in the past three months. Also, he has experienced joint pain for the last three months. Lower back and knee pain are also linked to OA. OA is also linked with the patient’s complaint of knee pain that has lasted many months to years.

Problems using stairs at his home also indicate OA (Mohammadinejad et al., 2020). Another historical finding is the use of a variety of NSAIDs to help the patient control pain in the joints and knee. The use of oxycodone in the past to relieve pain also indicates severe OA. Other history findings include joint stiffness that increases when he sits or sleeps for some time, a fracture in the left hip 11 years ago, and a previous knee injury.

Apart from historical findings, physical findings show that the patient has OA. One of the findings is that he feels pain when his right hip is raised to 90°. His right knee is tender to touch, mild tenderness in the left hip and pain in the spine that worsens when flexed forward. Reduced range of motion in the left need and decreased strength in the lower joints, crepitus present with the movement of the right knee, and muscles also indicate OA (Mohammadinejad et al., 2020).

Crepitus as it Relates to Osteoarthritis

A grating or crunching sound that accompanies the movement of a joint is known as crepitus. While joint crepitus is frequent in old age, not all cases indicate an underlying illness. On the other hand, joint crepitus typically indicates joint injury when it is accompanied by discomfort or swelling (Pazzinatto et al., 2019). Crepitus is frequently caused by arthritis, especially OA, particularly in the elderl