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Chapter 51. Osteoarthritis

Which of the following is a sign or symptom of a patient with clinical presentation of OA?

a. Joint stiffness with rest

b. Normal range of motion with joint

c. Joint stability

d. Joint stiffness 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. OA patients will experience relief of stiffness with movement (gelling phenomenon) of the joint. Stiffness worsens with rest.

Answer e is incorrect. OA 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 (PMH) is significant for dyslipidemia treated with gemfibrozil and diabetes with NPH 10 units bid 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?

a. Skin depigmentation

b. Adrenal insufficiency

c. Joint infection

d. Hyperglycemia

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 OA?

a. Improve mobility

b. Weight loss


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