Response to Student Post

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Both osteoarthritis and rheumatoid arthritis present with several of the same manifestations, such as joint pain and stiffness. How do the two disorders differ?

Osteoarthritis is a noninflammatory disorder of the joint/s due to the loss and damage of cartilage, osteophytosis, bone changes, degree of synovitis, and thickening of the joint capsule (McCance & Huether, 2019). Manifestations include mostly due to aging. Joint pain that involves pain and stiffness in weightbearing or loadbearing joints is associated with osteoarthritis. Evaluation includes of radiologic studies and clinical assessments. Treatment is associated with the severity of pain and immobility and include surgical, pharmacological, and non-pharmacological interventions (McCance & Huether, 2019).

The difference between osteoarthritis and rheumatoid arthritis is that RA is a chronic, inflammatory autoimmune disease that involve tissue, organs, and affects the joints. RA causes synovial inflammation, joint swelling, ankylosis, and destruction of articular cartilage (McCance & Huether, 2019). Manifestations include a slow gradual change of inflammation that causes fatigue, weakness, anorexia, aching, and stiffness (McCance & Huether, 2019). With gradual time, the joints are inflamed and lose mobility due to stiffness and mild synovitis. Evaluation for RA includes serological tests, erythrocyte sedimentation rate (ESR), and specifically anti-citrullinated protein antibody (ACPA). Some treatments include DMARDs and biological DMARDs, NSAIDs and steroid injections (McCance & Huether, 2019).

 

A child born with osteogenesis imperfecta is at risk for pathological fractures. Explain the pathophysiology of this disorder and the associated risk factors.

Osteogenesis imperfecta (OI) is a heterogeneous systemic connective tissue disorder correlating to low bone mass and fragility causing pain, immobility, skeletal deformities, and growth deficiency (Rossi et al., 2019). A decrease in bone strength causes an increase in no trauma, low-trauma fractures or fractures in atypical places (Rossi et al., 2019). The signs, symptoms, and complications of OI is correlated closely to the type that one has. For example, OI Type III is associated with severe teeth brittleness and malocclusion (Rossie et al., 2019). OI Type I, hearing loss can be experienced in the 2nd or 3rd decade of life (Rossi et al., 2019). There are many risk factors that contribute to OI. Pulmonary complications of OI can cause an increase of morbidity and mortality rate due to extrinsic factors such as rib fractures, scoliosis, and muscle weakness. Also, intrinsic lung abnormalities such as a decrease/impairment in pulmonary function with aging affect those with OI but those who have OI Type III are more significantly impaired (Rossi et al., 2019).

 

References

McCance, K.L., & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.

 

Rossi, V., Lee, B., & Marom, R. (2019). Osteogenesis imperfecta: advancements in genetics and treatment. Current opinion in pediatrics, 31(6), 708–715. https://doi.org/10.1097/MOP.0000000000000813

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Solution

Response to Student Post

Hello colleague. This is a great discussion on the differences between osteoarthritis and rheumatoid arthritis. I have earned that osteoarthritis is non-inflammatory while rheumatoid arthritis is inflammatory. Therefore, clinicians should look out for features of inflammation when assessing patients presenting with joint pain (Mohammed et al., 2020). In addition, to your discussion, I found that osteoarthritis is characterized by deep joint pain aggravated by extensive joint use. It also presents with a reduced ROM in affected joints and Heberden nodes. Joint stiffness in osteoarthritis occurs during rest, and it also has joint stiffness in the morning that occurrs less than 30 minutes. On the other hand, the morning joint stiffness in rheumatoid arthritis persists more than an hour (Mohammed et al., 2020). Besides, rheumatoid arthritis presents with systemic symptoms, including anorexia, fatigue, weight loss, and low-grade fever.  Clinicians must take a thorough patient history to establish the presence of these symptoms.

The discussion on Osteogenesis imperfecta (OI) was also informative. I learned that OI is a genetic disorder that presents at birth. Thus, children presenting with low bone mass, fragile bones, skeletal deformities, and growth deficiency should be assessed for OI (Sam & Dharmalingam, 2017). Besides, I learned that there are four types of OI with varying genetic causes. Type I and IV are autosomal dominant, while II and III are autosomal recessive. From my research, I established that hearing loss occurs in 50-65% of OI patients and can be present in the four types (Sam & Dharmalingam, 2017). Furthermore, I found that the diagnosis of OI is clinical. Types I and IV are managed with Growth hormone for growth-responsive children. Bisphosphonates are administered to increase bone density and reduce fracture risk and bone pain.

References

Mohammed, A., Alshamarri, T., Adeyeye, T., Lazariu, V., McNutt, L. A., & Carpenter, D. O. (2020). A comparison of risk factors for osteo- and rheumatoid arthritis using NHANES data. Preventive medicine reports20, 101242. https://doi.org/10.1016/j.pmedr.2020.101242

Sam, J. E., & Dharmalingam, M. (2017). Osteogenesis Imperfecta. Indian journal of endocrinology and metabolism21(6), 903–908. https://doi.org/10.4103/ijem.IJEM_220_17

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