Generalized stiffness and joint pain may be the presenting symptom of many conditions with which the final diagnosis can be thoroughly done after a consideration of various diseases. Moreover, the symptom generally associated with bone or joint disease, although it may occur articular or skeletal changes are minimal. The 64 year old female patient presented in the hospital with increased stiffness and pain in the joints could be suffering from various diseases, such as rheumatoid arthritis, osteoarthritis, pain dysfunction syndrome, or polymyalgia rheumatica.
Pain dysfunction syndrome is characterized by pain around the joints, with joints producing clicking sounds and is common in females in the ages of sixty and above. However, the patient had no clicking joints hence cannot be suffering from pain dysfunction syndrome. Polymyalgia rheumatica, on the other hand, is an inflammatory disorder that causes pain and stiffness on the neck, arms, hips, and shoulders. People with rheumatoid arthritis experience inflamed membranes around their joints. The membranes release enzymes that cause the surrounding cartilage and bone to wear away (Broussard, 2005).
Rheumatoid arthritis causes pain, swelling, and stiffness around the joints, particularly in the hands and feet, and affects women mostly between 20 and 50 years of age. Osteoarthritis mostly affects the elderly people above the age of 60, especially the obese, those with trauma to the joints, and women. It involves degeneration of articular cartilage in the lumbar vertebrae, knees, and hips. Moreover, it is characterized by enlargement of DIPs and PIPs, which are Herbeden’s nodes and Bouchard’s nodes, respectively. Further, joints ache and cartilage is lost beginning on the medial side (Broussard, 2005).
Opioids are usually administered to osteoarthritis patients to treat the pain, especially in the nodes. However, they are used if the patient has not responded to acetaminophen or NSAID therapy or cannot tolerate the opioids. Moreover, opioids should be prescribed at low dosages with close monitoring to avoid the risk of dependence. However, the acetaminophen administered is not as effective as non-steroidal anti-inflammatory drugs, NSAID for pain and on motion and at rest. Further, supplements, for instance, chondroitin and glucosamine are effective for moderate to severe osteoarthritis when combined together.
Additionally, corticosteroid injections provide relief of osteoarthritis pains and are cheaper compared to hyaluronic acid injections. However, the use of intra-articular corticosteroids relieves the pain for short periods lasting for 4 to 8 weeks. Lidocaine is also injected to provide immediate relief of osteoarthritis pain. The acetaminophen should be administered at 650 to 1000 mg four times a day and not more than that to avoid the risk of liver toxicity. Moreover, other over-the-counter or prescription medication that may contain acetaminophen should be avoided. NSAIDs are superior to acetaminophen and should be taken cautiously as they may cause adverse effects, such as renal dysfunction, gastrointestinal bleeding, and raise the blood pressure (Hunter & Lo, 2008).
Cyclooxygenase-2, COX-2 inhibitors, for instance, celecoxib improve the gastrointestinal adverse effects. Celecoxib differs from naproxen in that celecoxib is a cox-1 inhibitor and is prescribed while naproxen is both a cox-1 and cox-2 inhibitor which is sold over-the-counter. Celecoxib is safer and rarely causes ulcer complications, cardiovascular thromboembolic and upper gastrointestinal events (Broussard, 2005). Before starting celecoxib, it is important for a patient to discuss their medical conditions with their doctor or pharmacist. Such conditions include pregnancy, breast-feeding, allergies to medicine or foods, history of kidney or liver disease, diabetes, bowel problems, asthma, nasal polyps, or low blood sodium. Moreover, some medicines may interact with celecoxib, such as anticoagulants causing stomach bleeding. Fluconazole’s side effects are aggravated by celecoxib, which also reduces the effectiveness of angiotensin-converting enzyme inhibitors (Lehne, 2013).