Case Study: Adult with Knee Pain and Fatigue

Mrs. Davis is a 58-year-old woman who presents to your clinic with worsening knee pain and increasing fatigue.

Chief Complaint

My right knee has been hurting for months, and now Im so tired all the time.

History of Present Illness

Right knee pain for the past 8 months

Pain worsens with activity, especially going downstairs

Reports morning stiffness lasting about 20 minutes

Occasional swelling after walking long distances

Fatigue for the last 3 months, worse with exertion

Denies trauma, but notes difficulty keeping up with daily activities

Physical Exam Findings

Right knee: crepitus with movement, mild swelling, tenderness along joint line

Left knee: normal

Hands/wrists: no swelling or redness

Conjunctiva: pale

Temperature: normal

No lymphadenopathy or splenomegaly

Laboratory Findings

Hemoglobin: 8.8 g/dL (low)

MCV: 62 fL (microcytic)

Ferritin: low

Reticulocyte count: slightly elevated

X-ray of right knee: joint space narrowing and osteophyte formation

Assignment Instructions

Using the case study above, respond to the following prompts in a well-developed paper:

1. Describe the pathophysiology of osteoarthritis in Mrs. Daviss knee.
2. What structural changes occur in the cartilage and joint space?
3. How do cytokines and mechanical stress contribute to the process?
4. Why is her knee pain worse with activity and relieved by rest?
5. How does this help differentiate osteoarthritis from rheumatoid arthritis?
6. Explain the likely cause of her fatigue.
7. What does the combination of low hemoglobin, low MCV, and low ferritin suggest?
8. How does this lab pattern connect to oxygen delivery and her symptoms of fatigue?
9. Why does pallor occur in anemia, and how does this relate to hemoglobin levels?
10. How does the elevated reticulocyte count reflect her bone marrows attempt to respond?
11. Connect both conditions: how might chronic musculoskeletal pain from osteoarthritis make her anemia-related fatigue more noticeable in daily life?
12. What complications should be monitored if her iron deficiency anemia is not treated?
13. What long-term complications should be monitored if her osteoarthritis progresses?

Requirements

• Your paper should be organized, concise, and follow APA formatting.
• Support your analysis with at least three scholarly references (textbook, peer-reviewed journals, or clinical guidelines).
• Address all instruction requirements thoroughly to demonstrate advanced synthesis of pathophysiology content.
• Length: 34 pages (excluding title page and references).