Junpei Hasumi writes:
The patient is Yoko Kashiwagi, a 42-year-old media executive and used to be a marathon runner in her college days. She kept running until her 30s. Then the amount of her exercise was decreased because of increased responsibility in her business and became zero for the last five years, which is the same time she started smoking. In addition, she has gained 7 to 8 kilos and is feeling difficulty in moving her left knee, which is the same place she injured during her college days. Now she needs some advice from a specialist. Three indispensable points to tell her about would be as follows.
1. clear diagnosis;
The first point is "what is needed to make a clear diagnosis? "
There are some typical symptoms of osteoarthritis all of which Ms Kashiwagi has. They are 1) pain or stiffness in or near a joint; 2) bony swelling in a joint;
3)crackling noises when moving a joint; 4) mild inflammation (swelling, redness, and tenderness) in a joint.
Data such as how fast the pain develops, one side or both, any general feeling of sickness or not, also can help in diagnosing. In Ms Kashiwagi's case, 1) the pain did not develop suddenly but has come over a long period; 2) she feels pain only on one side; 3) she has no weight loss or fever. These are common in osteoarthritis but not in rheumatoid arthritis.
On the other hand, 1) she has some inflammation in the joint; 2) she feels more fatigued recently.These are common in rheumatoid arthritis but not in osteoarthritis.
To summarize, she has both aspects of osteoarthritis and rheumatoid arthritis.Though it seems osteoarthritis is more likely than rheumatoid arthritis, it is still too early to diagnose her condition. In order to complete the diagnosis, Ms. Kashiwagi's medical history, a physical examination, and special tests and/or X-rays are needed. These will help the doctor determine whether the problem is arthritis and, if so, which type of arthritis it is, osteoarthritis or rheumatoid arthritis.
The second point is " what can Ms. Kashiwagi start doing now to relieve her pain? " Ms. Kashiwagi is refusing surgery. So if it becomes clear that she has severe osteoarthritis, another kind of treatment ought to be introduced as follows.
First, medication will have to be avoided if possible since it may cause some side effects. But when it can't be avoided, the doctor may prescribe some medication to Ms. Kashiwagi. There are a great variety of drugs and the doctor will choose the best prescription. What Ms. Kashiwagi must do is obey the doctor's advice faithfully, have positive thinking and try her best.
Second, heat and cold could be listed in the treatment. Heat relaxes the muscles around the joint. Cold numbs the area and relieves the pain. But which of these to take and how long to apply it must be paid a great attention.
Third, to stop smoking will also be a help because smoking is a strong risk factor that develops rheumatoid arthritis. Even apart from this point, smoking should not be recommended because it may cause many bad effects on her body which may reduce her physical power to fight diseases.
Fourth and most important, weight loss and exercise are usually given the first priority. As Ms. Kashiwagi has gained about 7-8 kilos for the last 2 years, in parallel with getting the pain, weight loss will be expected to lighten the burden to her knee. Exercise will not only help her lose weight but also strengthen muscles surrounding the joint. Moreover, it may help her be free from mental stress that might give bad effects to osteoarthritis. But to be careful of too much exercise is very important.
The third point is "what kind of attitude can Ms. Kashiwagi take to live with osteoarthritis?" First, to make Ms Kashiwagi feel relieved, it will be good to tell her to have proper knowledge about her arthritis. The more she knows about it, the more she will know how to handle it. Making contact with the Arthritis Foundation will be an encouragement since she will meet specialized people who are accustomed to give advice to patients like her. For the same reason, it will be good she gets contact to a support group where she can meet those who have osteoarthritis and can share anxiety with her.
Second and more important, thinking positively will be good. To be optimistic can give her a hint to find joy and happiness with osteoarthritis. So it will be required to tell her to know how to be free from stress or negative feeling, and exercise can be a help here as analyzed above.
Unfortunately, osteoarthritis can't be cured with today's medicine. But it can be treated well and patients can spend common life with this arthritis. This applies to Ms. Kashiwagi, too. So she should never give up.
2. what she can do;
3. required attitude towards her problem.
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