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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. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.
Case Study Questions

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.
Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.
Case Study Questions

Name the most common risks factors for Alzheimer’s disease
Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
Define and describe explicit and implicit memory.
Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
What would be the best therapeutic approach on C.J.

Full Answer Section

Osteoarthritis vs. Rheumatoid Arthritis:

Feature	Osteoarthritis	Rheumatoid Arthritis
Cause	Cartilage wear and tear	Autoimmune disease
Joints Affected	Weight-bearing (knees, hips)	Symmetrical (small joints first)
Symptoms	Stiffness, pain worse with use	Morning stiffness, fatigue, fever
Diagnosis	X-ray, physical exam	Blood tests, X-ray, imaging

drive_spreadsheetExport to Sheets Treatment Options for G.J.: Non-pharmacological:

Weight management: Crucial for reducing joint stress.
Exercise: Low-impact activities like swimming or physical therapy to improve flexibility and strength.
Heat/cold therapy: To manage pain and inflammation.
Assistive devices: Canes or braces to support joints.

Pharmacological (consider G.J.'s medication history):

Acetaminophen: For mild pain (safer than NSAIDs for her stomach).
Topical NSAIDs: Gels or creams applied directly to the knee can reduce inflammation without systemic side effects.
Tramadol: A weaker opioid that might be an option if acetaminophen and topical NSAIDs aren't sufficient.

Osteoporosis Concern:

Explain the difference: Osteoporosis weakens bones, while OA affects cartilage.
Reassurance: Lack of nonclinical manifestations suggests she might not have osteoporosis.
Recommend DEXA scan: A painless X-ray-like test to measure bone density.
Calcium and vitamin D supplements: If needed based on DEXA results.

H.M. - Potential Alzheimer's Disease Risk Factors for Alzheimer's Disease:

Age: Over 65 is a major risk factor.
Family history: Having a parent or sibling with Alzheimer's increases risk.

Types of Dementia:

Alzheimer's disease: Most common, characterized by progressive memory loss and cognitive decline.
Vascular dementia: Caused by blood flow problems in the brain, leading to step-wise cognitive decline.
Dementia with Lewy bodies: Abnormal protein deposits in brain cells cause memory problems, movement issues, and hallucinations.
Frontotemporal dementia: Affects personality, behavior, and language due to degeneration in the frontal and temporal lobes.

Explicit vs. Implicit Memory:

Explicit memory: Conscious recollection of facts and events (e.g., remembering your birthday).
Implicit memory: Unconscious skills and habits (e.g., riding a bike). Alzheimer's primarily affects explicit memory.

Diagnosis of Alzheimer's Disease:

National Institute on Aging-Alzheimer's Association (NIA-AA) Criteria:
- Cognitive decline in one or more areas (memory, language, etc.)
- Affects daily life
- Progressive (worsens over time)
- Other causes ruled out (e.g., medication side effects, depression)
Diagnostic tests: No single test, but a combination of medical history, mental status exam, and sometimes brain imaging (CT scan or MRI) may be used.

Best Therapeutic Approach for C.J.: The best approach for G.J. would be a multimodal approach combining:

Non-pharmacological interventions: Weight management, exercise, heat/cold therapy, assistive devices.
Safer pain management: Acetaminophen and topical NSAIDs if needed. Tramadol as a possible alternative.
Physical therapy: To improve joint function and reduce pain.
Referral to a rheumatologist: For further evaluation and management.

Additional Notes:

Consider occupational therapy to help G.J. adapt to limitations and maintain independence.

Sample Answer

G.J. - Osteoarthritis

Osteoarthritis Definition and Differences:

Osteoarthritis (OA): A degenerative joint disease characterized by cartilage breakdown and inflammation in the joints. It's the most common form of arthritis.
Osteoporosis: A bone disease causing decreased bone density and increased fracture risk. It's not the same as osteoarthritis, although both can affect the elderly.

Risk Factors in G.J.'s Case for Osteoarthritis:

Age: Over 65 is a major risk factor.
Weight gain: Excess weight puts stress on weight-bearing joints like knees.
Previous joint injury: Not mentioned but could be a factor.
Family history: Not mentioned for OA, but relevant for osteoporosis.
Sex: Women are more prone to OA in the knees.