Chapter 50: Osteoarthritis
Which of the following is a sign or symptom of a patient with clinical presentation of osteoarthritis?
a. Joint stiffness with rest
b. Normal range of motion with joint
d. Joint pain with movement
e. Frictionless joint movement
Answer a is correct. Patients will experience a stiffening of the joint at rest and improved mobility with increased movement.
Answer b is incorrect. Patients have a limited range of motion because of abnormal joint structure.
Answer c is incorrect. Patients will experience joint instability secondary to pathophysiological changes leading to abnormal anatomy.
Answer d is incorrect. Osteoarthritis patients will experience pain relief with movement of the joint. Pain worsens with rest.
Answer e is incorrect. Osteoarthritis patients experience friction with movement as bone may move against bone secondary to cartilage destruction.
SL is a 62-year-old obese man with a history of degenerative joint disease in his left knee. Past medical history is significant for dyslipidemia treated with gemfibrozil and diabetes with NPH 10 U at bedtime and glipizide 10 mg bid. Blood sugar readings are not at goal with HgA1c of 8.5%. Current blood pressure is 130/80 mm Hg. He receives his second injection of 40 mg of Kenalog in his left knee today. Which side effect could cause a drug–disease state interaction in this patient?
Answer d is correct. Patient is a diabetic. Glucocorticoid use is associated with carbohydrate intolerance and hyperglycemia. This would necessitate closer monitoring of his diabetes.
Answer a is incorrect. Skin depigmentation may occur with corticosteroids. However, this is not a disease drug state interaction this patient is at risk for. Increased pigmentation can be a sign associated with adrenal insufficiency.
Answer b is incorrect. Patient is not manifesting signs of hypotension, fever or symptoms of weakness, anorexia, or myalgia associated with adrenal insufficiency. Adrenal insufficiency is a life-threatening situation.
Answer c is incorrect. He does not report any joint infection with symptoms of painful joint and abnormal white blood cell count.
What is the primary objective of pharmacologic therapy for osteoarthritis?