Case Diagnosis: Osteoarthritis Paper Example

Introduction

An 80-year-old farmer complains of pain and swelling in his right knee for the past 5 years. He complains of stiffness in the joint when he wakes up in the morning and after moderate exercise. He says the pain is relieved by rest. His left knee appears enlarged and deformed. He has no associated systemic complaints.

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Case diagnosis: Osteoarthritis.

Introduction and Epidemiology

Osteoarthritis is a clinical disorder characterized by joint pain that limits functionality and reduced the quality of life. The syndrome manifests in hips, knees, and hand joints. The effects of osteoarthritis are a pain, inability to function and inability to perform daily activities. Pain is a bio-psychosocial issue that that reduces self-efficiency lowers expectations and causes changes in sleep, mood, and coping abilities. Minimal changes on an x-ray scan have an implication of extreme pain. Modest changes in the structure of joints come along with minimal symptoms. The condition comes as a result of many diverse aspects aside from age. Treatment options entail pharmacological and non-pharmacological alternatives. The options offer a guideline of effective interventions meant to regulate symptoms of the condition and enhancing the functionality of human beings in their daily endeavors. Characteristics of the condition include cartilage loss, restructuring of adjacent bones as well as inflammation. Traumatic experiences may prompt the need to repair the joint.

An osteoarthritis; is a prevalent form of arthritis. The rates of prevalence of osteoarthritis and reported occurrences vary extensively because of diverse case definitions of the condition. First of all, Osteoarthritis can be defined along the lines of radiography as radiographic osteoarthritis or typical symptoms as symptomatic osteoarthritis (Zahra et. al. 2013). It can also be denied by both. Under the approach of radiographic criteria, proximal and distal joints of the hand's phalanges tend to be more prone to osteoarthritis. The features show no or very small aspects that relate them to asymptomatic. The hip and knee as the second and third regions of radiographic osteoarthritis are in most cases symptomatic. Other frequent sites of radiographic osteoarthritis are metacarpal and metatarsal joints. However, wrists, shoulders, metacarpal joints in the phalanges and elbows hardly ever develop idiopathic osteoarthritis.

Pathogenesis (Risk factors)

Risk factors can be divided into genetic factors that manifest for hand, hip and knee cases, constitutional factors entailing obesity, aging and sex, and biomechanical risk factors such as injuries at the joints, reduced strength in the muscle and laxity of the joints (Musumeci et. al. 2015). Age is a common risk factor in regards to osteoarthritis. The impact of the age aspect supersedes the probable factors relating to the kind of joints involved. In most cases, the rates of prevalence of osteoarthritis are high in men after 50 years and in women after 40 years. The rates of prevalence are high in both radiographic osteoarthritis and symptomatic osteoarthritis. This condition is rarely present in people under the age of 35 years. Normally, the secondary causes of osteoarthritis manifest in individuals below the age of 35.

Sex: Research has identified an association between the prevalence of osteoarthritis and women. Women are more prone to the condition as opposed to men. There is a high prevalence of hand osteoarthritis in women. Additionally, cases of isolated knee osteoarthritis are more common in women as compared to men while hip osteoarthritis is common in men. Notably, women have higher chances of experiencing reporting pain in affected joints as compared to men.

Obesity: Obesity raises chances of developing radiographic osteoarthritis in women. The disorder also increases the susceptibility of women to hip osteoarthritis. Obesity is a modifiable risk factor; consequently, it can be controlled. Notably, patients need to receive advice on a regular basis to reduce the likelihood of developing the condition.

Joint stress: Stresses in joints occur as a result of persistent infliction of injury and personal trauma. The joint stress situation enhances the likelihood of developing secondary (non-idiopathic) osteoarthritis. It may also occur in joints that have not incurred primary osteoarthritis. However, there is a high prevalence of knee osteoarthritis in adults who might have participated in occupations that involve arduous activities characterized by repetitive bending of knees and intense exercises. Less strenuous activities are less likely to cause knee osteoarthritis in individuals in the elderly stages.

Genetics: experiments relating to twin studies have made it possible to identify the contribution of the gene framework in the development of osteoarthritis. In other instances, osteoarthritis manifest as a result of genetic syndromes such as familial chondrocalcinosis and Stickler syndrome. Studies relating to genomes help in evaluating specific chromosomes entailed in cartilage structures, bone structures and links to familial osteoarthritis.

Pathology

The pathology of this syndrome starts by affecting the cartilage before affecting the entire joint. The process begins with the development of a crack on the surface of the cartilage which leads to an irregular shape. The cracks deepen and widen causing erosion to portions of the joint cartilage. Microscopic chondrocytes multiply in large numbers hence clustering art the damaged area of the cartilage. The cells trigger cytokines and enzymes that cause the breakdown of cartilages are released. The incapability of the cartilage to withstand compressive forces loosens and speeds up the process of wearing down. Osteocytes under the cartilage become active as a result of the effect of cytokines leading to thickening and stiffening of the bones (Goldring, 2006). Attempts to form new cartilages get vascularized by cytokines. Deposition of calcium at the cartilage results in bone formation. The bone manifests as outgrowths of osteophytes. They are evident in x-rays after the maximum loss of the cartilage. Afterward, cytokines inflame the synovial tissue leading to an increase in the number of cells and fluids. Deformations and swelling stretch the ligament leading to joint instability and increases vulnerability to injury. Pain reduces the victim's ability to participate in activities leading to weakening of associated muscles. The inability of weak muscles to support the joint effectively results in more damage. Notably, the inflammation and breakdown of the cartilage result in weak joint protectors that effect a vicious cycle of rapid disease progression.

Clinical Presentation and Complications

Osteoarthritis exposes patients to diverse complications depending on the duration of the illness in their lives. The first possible complication is reduced mobility. People with osteoarthritis find it challenging to move around. Moving can enhance the risks of encountering accidents and other injuries. Severe pain and reduced mobility trigger the need for a surgical operation. Complications may also arise in and around the joint. Some of them include chondrolysis which is the total cartilage breakdown resulting in slack tissue materials at the joints, osteonecrosis which refers to the death of a part of a bone that can only be removed through surgical procedures, stress fractures that are hairline crack in a bone due to continuous stress, internal bleeding in the joint, infections at the joint and wear and tear of ligaments and tendons at the joints affecting stability. Diagnosis of this condition might lead to stress and depression. Additionally, Osteoarthritis at the ankle results in extreme pain when the victim walks leading to the formation of a union at the joint (Khalid et. al. 2017). Patients should avoid wearing shoes that cause pain. They should also talk to doctors and people with a similar condition to gain support.

Conclusion

Notably, treatment of the condition involves pain reduction. The Chinese have an extraordinary approach towards paint reduction. In Chinese Medical Practice, Osteoarthritis (OA) is a kind of Pain Obstruction Syndrome or Bi Syndrome that results from external wind invasion, dampness and cold. The explanation normally has an implication of traumas, genetic aspects, sprains and overuse. These aspects tend to result in an impediment to the flow of Blood and Chi in the channels. There are a number of internal organs that are associated with the production of diverse diseases. Spleen deficiency causes aggravated dampness, pain in joints and swelling of joints. Deficiency in yang leads to chronic pain in joints that tends to intensify with extreme coldness. Pain transiting from joint to joint is an indication of blood deficiency. Yin deficiency causes swelling and warm painful joints. Chronic conditions of the organ-oriented diseases lead to body fluids stagnation at the joints. Condensation of the fluids results in phlegm that influences swelling and deformities in the affected joints. Persistent attacks may lead to the production of a stasis of blood that triggers paint. The healing pattern entails therapeutic procedures following a set of protocols. Treatment patterns for the Chronic Painful Obstruction Syndromes differ depending on clinical expectations. Recommendations for pain above the knee is SP 34, pain on the lateral side is GB 34, ST 36 and GB 33 and pain on the inner side of the knee is SP 9, LR 8 and LR 7 (Yang et. al. 2017). In other cases, Chinese herbal medicines such as Shu Feng Huo Luo Pian can help in relieving symptoms. For the case under study, SP 4 and PC 6 can be reinforced on the right and left to allow the penetrating vessel to open up. Reinforcement of ST 30 would enhance the flow of chi on the penetrating vessel. Needling LR 8 by even method nourishes the liver to enhance the flow of Chi. LR may be reduced to local point and KI E reinforced to stimulate the ability of the Kidney to control bones. Reinforcement of SP 6 stimulates the spleen to eradicate the swelling. Stimulation of SP 9 by even method has an impact of stimulating the spleen. The remedy for this case also dictates the reduction of all local points. After a twice a week treatment for six weeks, the patient should go for treatment at least monthly intervals due to the structural knee changes due to his age.

References

Goldring, S. (2006). Clinical aspects, pathology and pathophysiology of osteoarthritis. Journal of Musculoskeletal and Neuronal Interactions, 6(4):376-378

Khalid, M., Tufail, S., Aslam, Z. & Butt, A. (2017). Osteoarthritis: From complications to cure. International Journal of Clinical Rheumatology, 12(6), 160-167.

Musumeci, G., Aiello, F., Szychlinska, M., Di-Rosa, M., Castrogiovanni, P. & Mobasheri, A. (2015). Osteoarthritis in the XXIst Century: Risk Factors and Behaviours that Influence Disease Onset and Progression. International Journal of Molecular Sciences, 16, 6093-6112.

Yang, M., Jiang, L., Wang, Q., Chen, H. & Xu, G. (2017). Traditional Chinese medicine for knee osteoarthritis. An overview of systematic review, 12(12).

Zahra, A., Malekinejad, H., & Vishwanath, B. (2013). The patho-physiology of osteoarthritis. Journal of Pharmacy Research, 7(1), 132-138.