Pharmacology (Anti-inflammatory and Analgesics). In the contemporary medical world, clinical features relating to the musculoskeletal system such as joint pain can be significant of multiple diagnoses. Echoing this assertion is a case scenario involving, Jonathan, a 56-year-old retired automobile mechanic with clinical features depicting musculoskeletal disorders. In essence, this paper aims at analyzing this case study to its practical details.
Central to the analysis is the determination of a befitting primary diagnosis, differential diagnoses and drugs that are necessary for the treatment of this patient.
Primary Diagnosis
Based on Jonathan’s clinical features, his most likely primary diagnosis is rheumatoid arthritis. That is for sure because in this medical condition, the affected persons present with inflammation of the affected area of the body. Moreover, rheumatoid arthritis results in patients having joint pains that come with periarticular involvement. Despite rheumatoid arthritis being a systemic disease, in its initial stages, it may start by affecting a single joint (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2013). Evidently, with this depiction of rheumatoid arthritis and Jonathan’s clinical presentation, it is beyond doubt that he is suffering from this condition.
Differential Diagnoses
Going by the clinical manifestation of Jonathan, he is a likely candidate of several differential diagnoses that are worth noting. That is for sure because one ought to rule out the differential diagnoses for the effective management of the patient. A case in point of a differential diagnosis is the osteoarthritis (OA). According to Copstead-Kirkhorn and Banasik, (2014), OA is a degenerative joint disorder in which patients present with localized joint pain and variable as well as the progressive course. A risk factor for this condition is an obese individual, whose weight on the joints is overwhelming. However, inflammation is not characteristic of this condition and therefore based on this reason, Jonathan’s primary diagnosis cannot be OA.
Notwithstanding, Jonathan’s clinical presentation is subject to the impression of gout disease. He is a likely candidate for this condition given that he presents with signs of inflammation (swelling, pain, and erythema) and periarticular involvement, which are all suggestive of the gout disease. Despite these clinical manifestations, his laboratory values of serum and urine uric acid suggest otherwise since they are normal. In gout disease, the expectation is that an individual presents with hyperuricemia (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2013). However, this is not the case in Jonathan’s clinical presentation and thereby making him an unfit candidate for the diagnosis of gout disease.
Pharmacological Plan for Primary Diagnosis (R.A)
Of the essence to the treatment of rheumatoid arthritis are three classes of drugs, namely, NSAIDs, disease-modifying antirheumatic drugs (DMARDs) and corticosteroids. The first line of therapy involves the use of NSAIDs and corticosteroids while the second line entails the use of DMARDs. NSAIDs and corticosteroids are essential for the cessation of the inflammation while the DMARDs target to prevent progression of RA (Copstead-Kirkhorn&Banasik, 2014).
That said, Jonathan should thus receive NSAIDs such as Aspirin (daily dosage 1000mg QID) whose mechanism of action is to inhibit the cyclooxygenase receptors that are responsible for inflammatory reactions (Koda-Kimble, &Alldredge, 2013). Moreover, corticosteroids like prednisone (5 to 15mg daily), which acts by inhibiting inflammatory response of the body is also beneficial to this patient. Finally, a DMARD such as methotrexate (7.5-25mg per week) is also of the essence to the management of Jonathan’s condition. The mechanism of action of methotrexate is inhibition of the enzyme necessary for the metabolism of nucleic acids (Domino, &Baldor, 2012).
Conclusion
Concisely, this discussion aimed at analyzing a case study involving retired mechanic who presents with knee pains and periarticular joint involvement at the clinic. Precisely, the paper has achieved this objective since it was able to identify the primary diagnosis, differential diagnoses and drugs that are necessary for the treatment of this patient. Going by this analysis, an implication drawn is the need for further assessment when one comes across a patient presenting with muscular problems like in the case of Jonathan. In the absence of such, individuals become victims of inappropriate management strategies.
References
Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2013).Primary care: A collaborative practice (4th ed.). St. Louis, Mo.: Elsevier Health Sciences.
Copstead-Kirkhorn, L., &Banasik, J. L., (2014). Pathophysiology (5th ed.).
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Domino, F. J., &Baldor, R. A. (2012). The 5-minute clinical consult 2012. Philadelphia, Pa: Wolters Kluwer Health/Lippincott Williams & Wilkins.
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Koda-Kimble, M. A., &Alldredge, B. K. (2013). Applied therapeutics: The clinical use of drugs.Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
