Mr. Q is a 56-year-old Hispanic male patient presenting to the clinic on 24th September 2018. The source of the data is subjective, as it is reported by this person himself.
“I am visiting today because I have been experiencing joint pain and a feeling of joint stiffness in my knee joints.”
The patient reports that for the past two months, he has been experiencing pain and stiffness in the knee joints. The pain was gradual in nature and was precipitated by walking and sitting for long hours. The person, however, reports that the pain was relieved only for some hours by medication but persisted thereafter. The man denies that the pain was radiating in nature. Two days before the patient decided to seek help, both the pain and stiffness of the joints had greatly intensified.
Past Medical History
The patient has no history of chronic medical conditions.
Past Surgical History
The patient has no history of undergoing surgery.
The man has a wife and two male kids. He is a college graduate as well as a businessman. He sells automobile spare parts and runs a garage. He has been smoking cigarettes for the past six years taking half a pack per day. The patient’s mother died from hypertension three years ago. His father is alive but was diagnosed with osteoarthritis of the hip joint five years ago. The patient takes two bottles of beer daily with about half a kilogram of roasted red meat. His culture prohibits him from discussing the course and prognosis of diseases, as it is viewed as a bad omen.
The patient has been on diclofenac, one tab once a day for the past one week.
The patient has no known allergies to any medications or food.
Review of Systems
The man had not detected abnormalities apart from the musculoskeletal system that showed slight deviations. The patient reports experiencing pain in the knee joints, which limits his range of motion as well as affects him to an extent he cannot walk comfortably.
The patient looks anxious and slightly obese. Mr. Q’s facial expression depicts that he is in pain, which can be rated 1 on a scale of 1-10. The patient is oriented and cooperative for examination.
The patient weighs 74 kg, has a height of 67 in, and a BMI of 26, which reflects that he is overweight. The patient’s oxygen saturation rate is 96% in room air. He has a blood pressure of 127/89 mmHg, pulse of 87 beats/min, and temperature of 37.9 0 C.
The patient has a normocephalic head, his eyes have no lesions, and his ears have a positive reflex bilaterally. The mucosa of the patient’s nose is pink, and his teeth are white with a normal dental formula.
The patient’s neck is supple, and he experiences slight tenderness on sideways movement of the head.
The man has no signs of cyanosis. He has a fast rhythmic pulse in bilateral extremities.
The patient’s respirations are not labored. On auscultation, he has equal lung sounds bilaterally in all the lung fields.
The patient’s abdomen is soft, non-tender on palpation, and the bowel sounds are present in all the quadrants.
The patient’s pubic hair is well-distributed, and there is no discharge from the urethral meatus.
The patient’s balance is well-coordinated.
His range of motion is maintained in the upper extremities. The lower extremities have a limited range of motion. The patient feels pain on circumduction and extreme adduction and abduction. Both knee joints are tender on palpation. The joints are stiff as well as slightly inflamed. The man’s knee joint size is bilaterally increased.
The patient’s skin is moist with no signs of generalized pallor.
The patient is well-groomed and has the ability to maintain rapport. However, he has signs of depression, as he looks sad and apprehensive.
An ECG test was conducted on the patient, and the results showed a normal sinus rhythm.
Anthrocentesis was also performed to exclude other possible causes of inflammatory arthritis.
From the detailed assessment of the patient and his presenting symptoms, it can be determined that his actual diagnosis is osteoarthritis (OA).
Rheumatoid arthritis and psoriatic arthritis are the major differential diagnoses for OA.
The patient is prescribed with ibuprofen 400 mg twice a day for one week, diclofenac 75mg once daily, and Tylenol 1g three times a day for one week (CDC, 2018). Additionally, the patient was injected with prednisone 10 mg bilaterally in each knee joint on the day of review (Dziedzic et al., 2018). Prednisone acts to reduce inflammation and pain in the joints.
The man had a one-hour physiotherapy session and is to schedule weekly physiotherapy appointments. An individual group discussion session was also scheduled with the objective of alleviating his depression.
A blood test was conduction on specificity of complete blood count. The test was conducted as a confirmatory test to rule out other possible causes of joint pain like rheumatoid arthritis or the presence of an infection.
The imaging test that was conducted on the patient was a knee X-ray. It was performed to give a clear view of the knee cartilage. The results showed a slight loss of the joint cartilage. The space between the joint bones had also narrowed. A slight bone spur had also bilaterally formed in the joint.
The patient did not have a major problem that needed a sling or splint.
The patient is scheduled to return after one week for review.
The man has been referred to Elaborate Orthopedic Center for senior review, further management, as well as possible joint arthroscope.
The patient was educated on how the application of cold compresses on the joints relieves pain. He also got information on necessary exercises to reduce weight. Additionally, the man was educated to improve his diet to include a variety of fruits and vegetables in order to elevate flavonoids in the body.
OA is a musculoskeletal system disease that affects multiple body joints. The commonly affected joints are the knees, hip, spine, and finger joints. In the case analysis, the patient’s knee joints were affected. OA has a steady onset and presents with joint pain, inflammation, and stiffness (Centers for Disease Control and Prevention (CDC), 2018). Mr. Q’s chief complain was joint pain and stiffness that had a gradual onset and has persisted for about two months. OA mostly affects males who are above 50 years of age due to continued wear and tear of the joints (National Center for Complemantary and Integrative Health (NCCIH), 2017). Mr. Q was a 56-year-old man with a business career that involved walking and squatting. Such aspects precipitate the wearing and tearing of cartilage. A genetic history of OA also affects a family’s progeny. Mr. Q’s father had been diagnosed with OA earlier, thus putting him at a more predisposed risk of contracting the disease.
An analysis of the objective data depicts that the patient’s musculoskeletal system was greatly affected. His knee joint had a limited range of motion accompanied by stiffness and tenderness on palpation. OA destroys the joint cartilage that cushions the joint bones from friction during movements, thus resulting in direct friction between the bones (NCCIH, 2017). Friction results in pain and stiffness, as the joint’s range of motion is limited. OA also affects the neurological system. Such aspect results in most patients presenting with psychiatric conditions, such as depression related to the pain and thought of immobility. Mr. Q presented with symptoms of depression. The patient’s BMI depicted that he was overweight, which is one of the major risk factors of OA (CDC, 2018). Being overweight increases the pressure on the joints, thus escalating their stress as well as resulting in quick joint wear and tear.
OA is the actual diagnosis, as the X-ray results showed a clear picture of cartilage destruction in the joint. The confirmatory tests done to rule out other possible inflammatory conditions such as anthrocentesis also confirmed the presence of OA. The presented risk factors of genetics and being overweight also aided in selecting OA as the final diagnosis. Rheumatoid Arthritis (RA) is a differential diagnosis, as it also affects the joints, has a gradual onset, and is also genetic. However, the inflamed joint in RA is soft and tender compared to OA where it is bony and firm (NCCIH, 2017). Psoriatic arthritis is also similar to OA in the essence that both diseases affect joints and result in joint pain and inflammation (NCCIH, 2017). However, in psoriatic arthritis, the affected joints also influence the nails of the extremity, hence resulting in pits or ridges.
The patient conducted the X-ray as a diagnostic test. A test is one of the imaging examinations in OA that provides a clear picture of the joints’ cartilages. A presence of bilateral bone spur in the knee joints of a patient’s X-ray results is connected to the pathophysiology of the OA disease. As the body tries to repair the destroyed cartilage, it triggers the rejuvenation of cartilages, bone, and tissues (CDC, 2018). The growth forms a bone spur and increases the size of the joint. The treatment was based on the current recommended guidelines that involve the use of NSAIDs and analgesics. Opioids are also used in extreme OA cases. The patient was started on Tylenol, ibuprofen, and diclofenac as outlined in the clinical guideline. Tylenol and diclofenac are pain killers that help reduce the joint pain. Ibuprofen is an NSAID that acts by reducing inflammation of the knee joints. The patient was not on any other medications, and therefore, there was no chance of drug interactions. The patient, however, was advised to monitor the effectiveness of the prescribed drugs.
The non-pharmacological therapy involved the increased exercise and weight reduction just as similar with the outlined patient’s education. Exercises increase the joints’ flexibility, strength, and balance (Dziedzic et al., 2018). The patient was also educated on diet to reduce the OA symptoms. Fruits are rich in flavonoids and contain anti-inflammatory properties that help in reducing inflammation. The patient is to come back after a week for review. A review is necessary for patients suffering from OA as most of these people are anxious and depressed (NCCIH, 2017). The patient was referred to an advanced orthopedic center for proper review and management. The other objective of the referral was arthroscope, as it is recommended for some patients with moderate cartilage destruction (Dziedzic et al., 2018). The arthroscope procedure involves surgical repair of the cartilage and ligaments.
The patient’s cultural belief is a bad omen to discuss the prognosis, and a course of a disease would result in worsening the condition. I respected the patient’s culture in the sense that I had to be sensitive not to discuss on the prognosis of the disease. I have learned from the case that there are several causes that could result to joint pain and inflammation. The one thing that I would have done differently is to perform a rheumatoid factor test, as the OA is almost similar to rheumatoid Arthritis.
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Mr. Q is a 56-year-old Hispanic male with osteoarthritis. The patient came to the clinic after gradual symptoms of bilateral knee joint pain and stiffness for two months. He visited the medical facility after the symptoms had intensified for two days. The patient’s father was diagnosed with OA 5 years ago. Mr. Q is overweight, and after the assessment, he conducted an X-ray that confirmed the diagnosis of OA. He was started on medications according to the clinical guidelines on OA. He is to be reviewed after one week and has been referred to elaborate orthopedic center for further management.