A sixty-five-year-old man by the name of MP comes to the hospital with a complaint of pain in his back, knees, and hips. He has experienced these symptoms for the last six months. To subdue the pain, he has been taking OTC Advil. MP describes the pain as stiffness and occasional shooting and aching pains all over. No swelling of joints has been reported. MP says that the OTC medications are losing their effect and he wants to find an alternative treatment. During the physical examination, tenderness on palpation has been recorded on both of his hips as well as crepitus on his knees. However, all blood work has been within normal limits. There may be multiple causes for these symptoms, and intensive treatment is required for the recovery.
Required Additional Information
Some additional tests are necessary to provide an accurate diagnosis. Due to the patient’s complaint of stiffness, a test of rheumatoid factors should be done, as well as an IPC diagnosis to rule out the possibility of rheumatoid arthritis (Smolen et al., 2013). Although the blood work has shown to be within normal limits, it would be useful to do a blood test in the presence of uric acid. This will help rule out the possibility of issues with purine metabolism that could be characterized by gout (Newberry et al., 2016). Furthermore, for some of the tests, the patient needs to have an x-ray of his joints and spine. These x-rays need to go through a densitometer to see if these symptoms are caused by osteoporosis or another issue with bones caused by aging (Cosman et al., 2014). The same x-rays would show the stage of possible arthrosis (Dejour, Walch, Deschamps, & Chambat, 2014). MP could benefit from a CT scan that would demonstrate the state of his joints (Misra et al., 2015).
Possible Issues Contributing to Symptoms
These symptoms are likely caused by osteoarthrosis formed on the base of osteoporosis that has already affected the knees and hips of the patient (Im & Kim, 2013). This disorder is characterized by the issues with the joints caused by a lack of liquid, as well as adverse effects on the surface of the joints caused by the destruction of cartilage layers and the creation of osteophytes, also known as bone spurs (Finzel et al., 2014). MP has reported that OTC medication has stopped controlling the symptoms. This phenomenon could be a sign that the affliction is progressing and is resisting OTC medication (McAlindon et al., 2014). As other possible reasons for these symptoms, it might be useful to consider trauma in the lumbar cord of the patient to be one of the causes, gout, and osteoporosis (Im & Kim, 2013).
Suggested Treatments
If the results of the tests show the osteoarthrosis diagnosis to be true, it would be sensible to support MP’s suggestion of injections into his knees. To specify, periodic treatment with intra-articular corticosteroids could provide comfort to the patient. This treatment could be combined with a wide variety of studies treatments. One of the more tested procedures involves two types of exercise ground and water-based. Ground-based exercise recommended for OA treatment includes t’ ai chi due to its favorable benefits for improving pain and physical function in patients with knee OA. Aerobics has also shown to provide positive effects on the patients. Water-based exercises have proved to have a smaller benefit for knee and hip OA treatment but could still be considered if the patient has a preference for water. Strength training can be combined with previous treatments due to its moderate effect on pain reduction and improvement of physical function. This type of training incorporates resistance-based lower limb and quadriceps strengthening exercises. It could be performed in groups, as well as individually (McAlindon et al., 2014).
Evidence shows that multiple joint OA could benefit from NSAIDs such as oral COX-2 Inhibitors. For example, an oral dose of 200mg per day or 100mg of Celebrex administered twice daily could relieve the pain of the patient. One of the more important aspects of treatment is the self-management and education of the patient. Group or telephone-based sessions have shown to have a significant benefit to patients in this condition. An implementation of a cane with this kind of OA might not prove to be of many benefits, but there is a chance that it would bring some quality of life improvements. Spa therapy has shown to have a positive effect on patients with multiple-joint OA. This kind of treatment includes Dead Sea salt or mineral baths, Sulphur baths, and radon-carbon dioxide baths. These treatments do not provide significant safety concerns (McAlindon et al., 2014).
If these treatments do not provide appropriate results, a biomechanical intervention should be considered. This could include knee braces, knee sleeves, and foot orthoses. Reviews suggested that they provide effective results in decreasing pain, joint stiffness, and required drug dosage, as well as improvement of physical function. Also, the adverse effects of these interventions have proven to be insignificant (McAlindon et al., 2014).
References
Cosman, F., de Beur, S., LeBoff, M., Lewiecki, E., Tanner, B., Randall, S., & Lindsay, R. (2014). Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis International, 25(10), 2359-2381.
Dejour, H., Walch, G., Deschamps, G., & Chambat, P. (2014). Arthrosis of the knee in chronic anterior laxity. Orthopaedics & Traumatology: Surgery & Research, 100(1), 49-58. Web.
Finzel, S., Sahinbegovic, E., Kocijan, R., Engelke, K., Englbrecht, M., & Schett, G. (2014). Inflammatory bone spur formation in psoriatic arthritis is different from bone spur formation in hand osteoarthritis. Arthritis & Rheumatology, 66(11), 2968-2975. Web.
Im, G. & Kim, M. (2013). The relationship between osteoarthritis and osteoporosis. Journal of Bone and Mineral Metabolism, 32(2), 101-109.
McAlindon, T., Bannuru, R., Sullivan, M., Arden, N., Berenbaum, F., Bierma-Zeinstra, S, … Underwood, M. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage, 22(3), 363-388.
Misra, D., Guermazi, A., Sieren, J., Lynch, J., Torner, J., Neogi, T., & Felson, D. (2015). CT imaging for evaluation of calcium crystal deposition in the knee: initial experience from the Multicenter Osteoarthritis (MOST) Study. Osteoarthritis and Cartilage, 23(2), 244-248.
Newberry, S., FitzGerald, J., Motala, A., Booth, M., Maglione, M., Han, D., …, Shekele, P. (2016). Diagnosis of gout: A systematic review in support of an American College of Physicians clinical practice guideline. Annals of Internal Medicine, 166(1), 27.
Smolen, J., Landewé, R., Breedveld, F., Buch, M., Burmester, G., Dougados, M., … Heidje, D (2013). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Annals of the Rheumatic Diseases, 73(3), 492-509.