Posted: June 29th, 2023

Case Study 1: Osteoarthritis

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.
Submission Instructions:

Include both case studies in your post.
Your initial post should be at least 250 words per case study, a total of 500 words for both, formatted and cited in current APA style with support from at least 2 academic sources per case study. Your initial post is worth 8 points.
You should respond to at least two of your peers, by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response before 11:59 PM ET Thursday, and comment on the posts of two classmates before 11:59 PM ET Sunday. NB: Responses to peers can be done on the same day, but not on the day the initial post is made.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

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Case Study 1: Osteoarthritis
Osteoarthritis (OA) is a progressive disease characterized by the destruction of joint cartilage, leading to painful, stiff, and swollen joints. It is the most common form of arthritis. Osteoarthrosis, on the other hand, is a term sometimes used to refer to a form of osteoarthritis that is caused by the aging process and wear and tear on joints, rather than by inflammation. Risk factors in this case include age, obesity (as indicated by the recent weight gain), and possibly gender (as OA is more common in women).
Osteoarthritis and rheumatoid arthritis (RA) are both forms of arthritis but have different causes and manifestations. OA is a degenerative disease often related to age and wear and tear, while RA is an autoimmune disease. OA often affects the hands, hips, and knees and is characterized by pain and stiffness that improves with movement. RA, on the other hand, often affects the hands and wrists, and is characterized by painful swelling and can lead to bone erosion and joint deformity. Diagnosis for both conditions often involves physical examination, patient history, and may include imaging tests and lab tests.
Treatment for OA often involves a combination of non-pharmacological and pharmacological approaches. Non-pharmacological treatments include exercise, weight loss, and physical therapy. Pharmacological treatments can include over-the-counter pain relievers, nonsteroidal anti-inflammatory drugs (NSAIDs), and in some cases, stronger prescription medications. In this case, the patient has already tried NSAIDs and opioids, so non-pharmacological treatments and possibly the use of other types of pain relievers or joint injections could be considered.
For the patient’s concern about osteoporosis, it would be important to assess her risk factors, which could include her age, gender, family history, and recent weight gain. Education could include information about the importance of regular weight-bearing exercise, a diet rich in calcium and vitamin D, and potentially the use of medications to help prevent bone loss.
Case Study 2: Alzheimer’s Disease
The most common risk factors for Alzheimer’s disease include age, family history, genetics, and certain lifestyle factors such as cardiovascular health.
Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia are all types of dementia, but they have different causes and symptoms. Alzheimer’s is characterized by memory loss and confusion, vascular dementia is often caused by a stroke or other interruption to the blood supply in the brain, dementia with Lewy bodies can cause symptoms such as hallucinations and sleep disturbances, and frontotemporal dementia often affects personality and behavior before memory.
Explicit memory refers to conscious, intentional recollection of factual information, previous experiences, and concepts. Implicit memory is a type of memory in which previous experiences aid in the performance of a task without conscious awareness of these previous experiences.
The National Institute on Aging and the Alzheimer’s Association have developed criteria for the diagnosis of Alzheimer’s that include clear evidence of decline in memory and thinking skills, gradual onset and worsening of impairment over time, and no evidence of other disorders that could explain the symptoms.
The best therapeutic approach for C.J. would likely involve a combination of medication to help manage symptoms, behavioral strategies to help manage changes in behavior, and support for her and her family to help cope with the disease.

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