Evidence-Based Management of Osteoarthritis
The case expert analysis describes the different management options for Mabel
Johnson's case, osteoarthritis. Apart from the rheumatic condition, Mabel Johnson has
co-morbid conditions such as peptic ulcer disease and renal disease. Noninvasive
options of treatment are best utilized in this case due to the existence of
contraindications to most pharmacological options. The interventions primary aim at
improving the quality of life for the patient through the elimination of pain,
improvement of muscular functional capacity, increase in muscular size and strength.
Physical therapy such as resistance training and aerobic exercise achieve the therapeutic
objectives without inflicting further harm or encouraging disease progression.
Noninvasive biomechanical interventions such as orthotics and knee braces offer
alternative remedies. Some orthotics include elevated wedge insoles while knee braces
include valgus-type and sleeve-type knee braces. While braces improve the
proprioceptive acuity of the joint, orthotics reduce the load on the joint. Pharmacologic
interventions for Mabel Johnson include analgesics such as tramadol or narcotic-type
analgesics in combination with NSAIDs like acetaminophen. The presence of gastric and
renal insufficiencies preclude the use of COX-2 inhibitors as NSAIDs. Despite having
gastric protective properties, COX-2 inhibitors would lead to thromboembolic
conditions in the elderly due to their platelet aggregation properties. In end-stage
disease, the patient can also consider total or partial joint replacement surgery.
Some areas for improvement in the patient encounter include identification of
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