Porth's Essentials of Pathophysiology, 4e

1137

Disorders of the Skeletal System: Metabolic and Rheumatic Disorders

C h a p t e r 4 4

3. A 65-year-old obese woman with a diagnosis of osteoarthritis (OA) has been having increased pain in her right knee that is made worse with movement and weight bearing and is relieved by rest. Physical examination reveals an enlarged joint with a varus deformity; coarse crepitus is felt over the joint on passive movement. A. Compare the pathogenesis and articular structures involved in OA with those of RA. B. What is the origin of the enlargement of the affected joint, the varus deformity, and the crepitus that is felt on movement of the affected knee? C. Explain the predilection for involvement of the knee in persons such as this woman. D. What types of treatment are available for this woman? 4. A 75-year-old woman is seen by a health care provider because of complaints of fever, malaise, and weight loss. She is having trouble combing her hair, putting on a coat, and getting out of a chair because of the stiffness and pain in her shoulders, hip, and lower back. Because of her age and symptoms, the health care provider suspects the woman has polymyalgia rheumatica. A. What laboratory test can be used to substantiate the diagnosis? B. What other diagnostic strategies are used to confirm the diagnosis? C. How is the disease treated? 1. Seeman E, Delmas PD. Bone quality—the material and structural basis of bone strength and fragility. N Engl J Med. 2006;354(21):2250–2261. 2. Khosia S, Melton LJ. Osteopenia. N Engl J Med. 2007;356(22):2293–2300. 3. Rosenberg AE. Bones, joints, and soft tissue tumors. In: Kumar V, Abbas AK, Fausto N, et al., eds. Robbins and Cotran Pathologic Basis of Medicine . 8th ed. Philadelphia, PA: Elsevier Saunders; 2010:1205–1219, 1235–1246. 4. Garcia RA, Klein MJ, Schiller AL. Bones and Joints. In: Rubin R, Strayer DS, eds. Rubin’s Pathology: Clinicopathologic Foundations of Medicine . 6th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012:1199–1272. 5. Simon LS. Osteoporosis. Rheum Dis Clin North Am. 2007;33:140–176. 6. Lewiecki CM. Managing osteoporosis: challenges and strategies. Cleve Clin J Med. 2009;26(8):457–466. 7. Kanis JA, for the World Health Organization Scientific Group. Assessment of osteoporosis at the primary-care level. Technical report . University of Sheffield, UK: World Health Organization Collaborating Centre for Metabolic Bone Diseases; 2008. 8. Lewiecki EM. Bone density measurement and assessment of fracture risk. Clin Obstet Gynecol. 2013;56(4):667–676. 9. International Osteoporosis Foundation. IOF one- minute osteoporosis risk test. Available at: https://www. iofbonehealth.org/sites/default/files/PDFs/2012-IOF_risk_test- english%5BWEB%5D_0.pdf. Accessed September 29, 2013.

SUMMARY CONCEPTS

R E V I EW E X E R C I S E S 1. A 60-year-old postmenopausal woman presents with a compression fracture of the vertebrae. She has also noticed increased backache and loss of height over the last few years. A. Explain how aging and the lack of estrogen contribute to the development of osteoporosis. B. What other factors should be considered when assessing the risk for developing osteoporosis? C. What is the best way to measure bone density? D. Name the two most important factors in preventing osteoporosis. E. What medications might be used to treat this woman’s condition? 2. A 30-year-old woman recently diagnosed with rheumatoid arthritis (RA) complains of general fatigue and weight loss along with symmetric joint swelling, stiffness, and pain. The stiffness is more prominent in the morning and subsides during the day. Laboratory measures reveal an elevated rheumatoid factor (RF). A. Describe the immunopathogenesis of the joint changes that occur with RA. B. How do these changes relate to this woman’s symptoms? C. What is the significance of her RF test results? D. How do her complaints of general fatigue and weight loss relate to the RA disease process? advancing age. One form of rheumatic disease that has a predilection for the elderly is polymyalgia rheumatica. A certain percentage of persons with polymyalgia rheumatica also develop giant cell arteritis (i.e., temporal arteritis) with involvement of the ophthalmic arteries, a condition that can cause blindness if not recognized and treated. ■■ Rheumatic diseases that affect children include juvenile idiopathic arthritis, juvenile dermatomyositis, and juvenile-onset spondyloarthropathies. Although the childhood form of the arthritis may be similar to that seen in the adult, there are manifestations and treatment issues that are unique to the younger population. ■■ Arthritis is the most common complaint of the elderly population.There is a difference in the manifestations, diagnosis, and treatment of some of the rheumatic diseases in the elderly compared with those in the younger population. Osteoarthritis is the most common form of arthritis among the elderly.The prevalence of rheumatoid arthritis and gout increases with

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