C h a p t e r 4 4
Disorders of the Skeletal System: Metabolic and Rheumatic Disorders
1137
R E V I EW E X E R C I S E S
1.
A 60-year-old postmenopausal woman presents
with a compression fracture of the vertebrae. She
has also noticed increased backache and loss of
height over the last few years.
A.
Explain how aging and the lack of estrogen
contribute to the development of osteoporosis.
B.
What other factors should be considered when
assessing the risk for developing osteoporosis?
C.
What is the best way to measure bone density?
D.
Name the two most important factors in
preventing osteoporosis.
E.
What medications might be used to treat this
woman’s condition?
2.
A 30-year-old woman recently diagnosed with
rheumatoid arthritis (RA) complains of general
fatigue and weight loss along with symmetric joint
swelling, stiffness, and pain. The stiffness is more
prominent in the morning and subsides during
the day. Laboratory measures reveal an elevated
rheumatoid factor (RF).
A.
Describe the immunopathogenesis of the joint
changes that occur with RA.
B.
How do these changes relate to this woman’s
symptoms?
C.
What is the significance of her RF test results?
D.
How do her complaints of general fatigue and
weight loss relate to the RA disease process?
SUMMARY CONCEPTS
■■
Rheumatic diseases that affect children
include juvenile idiopathic arthritis, juvenile
dermatomyositis, and juvenile-onset
spondyloarthropathies. Although the childhood
form of the arthritis may be similar to that seen in
the adult, there are manifestations and treatment
issues that are unique to the younger population.
■■
Arthritis is the most common complaint of the
elderly population.There is a difference in the
manifestations, diagnosis, and treatment of
some of the rheumatic diseases in the elderly
compared with those in the younger population.
Osteoarthritis is the most common form of
arthritis among the elderly.The prevalence of
rheumatoid arthritis and gout increases with
advancing age. One form of rheumatic disease that
has a predilection for the elderly is polymyalgia
rheumatica. A certain percentage of persons with
polymyalgia rheumatica also develop giant cell
arteritis (i.e., temporal arteritis) with involvement
of the ophthalmic arteries, a condition that can
cause blindness if not recognized and treated.
3.
A 65-year-old obese woman with a diagnosis of
osteoarthritis (OA) has been having increased
pain in her right knee that is made worse with
movement and weight bearing and is relieved by
rest. Physical examination reveals an enlarged joint
with a varus deformity; coarse crepitus is felt over
the joint on passive movement.
A.
Compare the pathogenesis and articular
structures involved in OA with those of RA.
B.
What is the origin of the enlargement of the
affected joint, the varus deformity, and the
crepitus that is felt on movement of the affected
knee?
C.
Explain the predilection for involvement of the
knee in persons such as this woman.
D.
What types of treatment are available for this
woman?
4.
A 75-year-old woman is seen by a health care
provider because of complaints of fever, malaise,
and weight loss. She is having trouble combing her
hair, putting on a coat, and getting out of a chair
because of the stiffness and pain in her shoulders,
hip, and lower back. Because of her age and
symptoms, the health care provider suspects the
woman has polymyalgia rheumatica.
A.
What laboratory test can be used to substantiate
the diagnosis?
B.
What other diagnostic strategies are used to
confirm the diagnosis?
C.
How is the disease treated?
R E F E R E N C E S
1. Seeman E, Delmas PD. Bone quality—the material and
structural basis of bone strength and fragility.
N Engl J Med.
2006;354(21):2250–2261.
2. Khosia S, Melton LJ. Osteopenia.
N Engl J Med.
2007;356(22):2293–2300.
3. Rosenberg AE. Bones, joints, and soft tissue tumors. In: Kumar
V, Abbas AK, Fausto N, et al., eds.
Robbins and Cotran
Pathologic Basis of Medicine
. 8th ed. Philadelphia, PA: Elsevier
Saunders; 2010:1205–1219, 1235–1246.
4. Garcia RA, Klein MJ, Schiller AL. Bones and Joints. In: Rubin
R, Strayer DS, eds.
Rubin’s Pathology: Clinicopathologic
Foundations of Medicine
. 6th ed. Philadelphia, PA: Wolters
Kluwer Health/Lippincott Williams & Wilkins; 2012:1199–1272.
5. Simon LS. Osteoporosis.
Rheum Dis Clin North Am.
2007;33:140–176.
6. Lewiecki CM. Managing osteoporosis: challenges and strategies.
Cleve Clin J Med.
2009;26(8):457–466.
7. Kanis JA, for the World Health Organization Scientific Group.
Assessment of osteoporosis at the primary-care level. Technical
report
. University of Sheffield, UK: World Health Organization
Collaborating Centre for Metabolic Bone Diseases; 2008.
8. Lewiecki EM. Bone density measurement and assessment of
fracture risk.
Clin Obstet Gynecol.
2013;56(4):667–676.
9. International Osteoporosis Foundation. IOF one-
minute osteoporosis risk test. Available at:
.
iofbonehealth.org/sites/default/files/PDFs/2012-IOF_risk_test-
english%5BWEB%5D_0.pdf. Accessed September 29, 2013.
