Mabel Johnson Case Study

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 chronic illnesses pre-existing with OA and early initiation of appropriate treatment options. First, it's essential to identify any preexisting conditions such as peptic ulcer disease and kidney diseases in the patient before formulating the treatment plan since the use of some NSAIDs is contraindicated in these conditions. Such drugs include nonselective NSAIDs, for instance, aspirin, that impair the protection of the gastrointestinal tract and increased cardiovascular risk through platelet aggregation. The clinician must also assess the extent and severity of symptoms such as pain and reduced function. Early initiation of low-intensity exercise is instrumental in reducing the pain and improving functional capacity while slowing down disease progression. Utilization of these non-pharmacologic interventions would have avoided the need for knee replacement surgery [ CITATION Gur02 l 1033 ]. Evidence-based techniques such as models of training can help improve clinical skills. .............................Continued.........................