19 Jan Musculoskeletal System: Inflammatory vs Degenerative Arthritis

NURS 6501 – Week 8 Case Study Assignment

Musculoskeletal System: Inflammatory vs Degenerative Arthritis

Important Case Instruction

*No laboratory or imaging data are provided. Your analysis should be based solely on the patient’s

clinical presentation and underlying pathophysiology.

Assignment Overview

In this case study, you will analyze a patient with progressive joint pain and functional decline. Using

advanced pathophysiology concepts, you will compare rheumatoid arthritis (RA) and osteoarthritis (OA),

determine the most likely diagnosis, and support your conclusions with primary, evidence-based

literature.

Length Requirement (per rubric): The body of the paper must be no more than 2 pages, excluding title

page and references.

Format: APA 7th edition with MSN Template

Sources: Minimum of 3 current, peer-reviewed primary sources

Case Scenario

Patient Case Scenario

Patient: Mrs. Eleanor R.

Age: 66 years

Sex: Female

Mrs. Eleanor R. is a 66-year-old Caucasian female, retired elementary school teacher who presents with

progressively worsening joint pain, stiffness, and functional decline over the past five years, with a

notable acceleration in symptoms during the last 12 months.

She reports waking each morning with severe stiffness lasting 1–2 hours, describing her hands as feeling

“locked and swollen” until she runs them under warm water. She notes bilateral pain and swelling in her

hands, wrists, and knees, with intermittent redness and warmth. By mid-afternoon, she experiences

profound fatigue and difficulty gripping objects, often dropping items such as coffee cups or keys.

Mrs. R. states she was initially told by a previous provider that she had “age-related arthritis,” but she

feels her symptoms are worsening rather than stabilizing. She reports increasing difficulty with fine motor

tasks, including buttoning clothes and opening jars, and recently stopped gardening due to pain and hand

weakness.

Lifestyle & Self-Directed Interventions

Page 1 of 4Mrs. R. describes her diet as “not great,” consisting largely of processed foods and minimal fresh protein

or omega-3 intake. She is, however, highly committed to self-care interventions, stating:

“I may not eat perfectly, but I never miss my vitamins.”

She takes vitamin D, vitamin C, magnesium, and turmeric daily. Six months ago, after reading online

testimonials, she independently began hyperbaric oxygen therapy (HBOT) at a private wellness center,

completing multiple sessions weekly. She reports partial pain relief, but persistent stiffness, swelling, and

progressive hand deformity.

Medical History

• Hypertension, well controlled

• Obesity (BMI 32)

• Former smoker (20 pack-year history; quit 10 years ago)

Family History:

• Mother with “ crippling arthritis” requiring early hand surgery

• Sister with an autoimmune condition requiring long-term immunologic treatment

Mrs. R. expresses frustration and concern, stating:

“I’m doing everything I can, but I feel like my joints are getting worse instead of better.”

Clinical Considerations for Analysis

At today’s visit, the provider notes visible swelling of the MCP and PIP joints bilaterally, reduced grip

strength, and difficulty rising from a seated position due to knee stiffness. No prior inflammatory markers

or autoimmune laboratory testing have been performed.

Page 2 of 4 CASE STUDY QUESTIONS (RUBRIC-ALIGNED) – Thoughts to consider in your writings for the

content – however, follow the entire rubric.

Rubric Criterion 1 – Primary Pathophysiological Processes (30 points)

Rubric language:

“Develop a case study analysis examining patient signs and symptoms. Discuss the primary

pathophysiological processes and their significance for symptom development and diagnosis”

Question 1: Pathophysiology and Diagnosis

1. Describe the primary pathophysiological mechanisms of:

o Rheumatoid arthritis (RA)

o Osteoarthritis (OA)

2. Using the patient’s clinical presentation, explain how these mechanisms account for:

o Prolonged morning stiffness

o Symmetrical joint involvement

o Pain, swelling, and functional impairment

3. Based on the patient’s signs and symptoms, identify the most likely diagnosis and provide a

clear, brief, evidence-based rationale.

Rubric Criterion 2 – Genetics and Risk Factors (30 points)

Rubric language:

“Describe the role genetic mutations play in the development of the disease and the risk factors that make

the patient more susceptible”

Question 2: Genetics and Disease Susceptibility

1. 2. 3. Discuss the role of genetic predisposition in the development of rheumatoid arthritis.

Compare this genetic contribution to osteoarthritis.

Identify and explain patient-specific risk factors that increase susceptibility to the most likely

diagnosis.

Rubric Criterion 3 – Racial/Ethnic Variables AND History/Lifestyle Factors (25 points total)

Rubric language:

“Explain any racial/ethnic variables that may impact physiological functioning AND explain factors in

the patient’s history and lifestyle that could have contributed to the development of the disease process”

Question 3: Racial/Ethnic Considerations, History, and Lifestyle Factors

1. Explain how racial or ethnic variables may influence:

o Disease prevalence

o Severity and progression

Page 3 of 4 2. 3. o Physiological functioning

o Access to diagnosis or treatment

Analyze how the patient’s history and lifestyle are contributing factor to the disease

development, symptoms progression and severity:

o Poor diet

o Obesity

o Vitamin supplementation

o Use of hyperbaric oxygen therapy (HBOT)

Clearly distinguish adjunctive symptom management strategies from disease-modifying

treatment.

IMPORTANT REMINDERS:

• This is a case-based analysis, not a textbook disease summary.

• Do not assume or create laboratory or imaging data.

• All discussion must be directly tied to the patient’s presentation.

• Avoid SOAP-note or charting language.

• Use primary, peer-reviewed literature to support all major claims.

• Supplements and HBOT should be discussed as adjunctive, not curative.

• Body of paper must not exceed 2 pages, per rubric or points will be deducted.

Concise, synthesis-based writing is expected. Papers that exceed page limits due to general

disease descriptions, TEXT BOOK STYLE WRITINGS, rather than case-focused analysis may

lose points under written criteria

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