NURS 6501 – Week 8 Case Study Assignment

Musculoskeletal System: Inflammatory vs Degenerative Arthritis

Differentiating between rheumatoid arthritis and osteoarthritis using patient clinical presentations in advanced nursing case studies improves accurate diagnosis and evidence-based care planning for joint disorders.

Important Case Instruction

• No laboratory or imaging data are provided. Your analysis should be based solely on the patient’s clinical presentation and underlying pathophysiology.

Recent guidelines emphasize relying on history and exam findings when initial tests are unavailable to guide preliminary assessments.

Assignment Overview

In this case study, you will analyze a patient with progressive joint pain and functional decline. Using advanced pathophysiology concepts, you will compare rheumatoid arthritis (RA) and osteoarthritis (OA), determine the most likely diagnosis, and support your conclusions with primary, evidence-based literature.

Students often find this comparison highlights the inflammatory nature of certain arthritic conditions over mechanical wear in others.

Length Requirement (per rubric): The body of the paper must be no more than 2 pages, excluding title page and references.

Format: APA 7th edition with MSN Template

Sources: Minimum of 3 current, peer-reviewed primary sources

Updated 2025 research stresses the importance of concise writing to meet strict page limits while integrating robust evidence.

Case Scenario

Patient Case Scenario

Patient: Mrs. Eleanor R.

Age: 66 years

Sex: Female

Mrs. Eleanor R. is a 66-year-old Caucasian female, retired elementary school teacher who presents with progressively worsening joint pain, stiffness, and functional decline over the past five years, with a notable acceleration in symptoms during the last 12 months.

Many patients in this age group report similar gradual onset, but acceleration often signals an underlying inflammatory process.

She reports waking each morning with severe stiffness lasting 1–2 hours, describing her hands as feeling “locked and swollen” until she runs them under warm water. She notes bilateral pain and swelling in her hands, wrists, and knees, with intermittent redness and warmth. By mid-afternoon, she experiences profound fatigue and difficulty gripping objects, often dropping items such as coffee cups or keys.

Mrs. R. states she was initially told by a previous provider that she had “age-related arthritis,” but she feels her symptoms are worsening rather than stabilizing. She reports increasing difficulty with fine motor tasks, including buttoning clothes and opening jars, and recently stopped gardening due to pain and hand weakness.

Current studies from 2024 indicate that symmetrical involvement like this is more common in autoimmune-driven arthritis.

Lifestyle & Self-Directed Interventions

Page 1 of 4Mrs. R. describes her diet as “not great,” consisting largely of processed foods and minimal fresh protein or omega-3 intake. She is, however, highly committed to self-care interventions, stating:

“I may not eat perfectly, but I never miss my vitamins.”

She takes vitamin D, vitamin C, magnesium, and turmeric daily. Six months ago, after reading online testimonials, she independently began hyperbaric oxygen therapy (HBOT) at a private wellness center, completing multiple sessions weekly. She reports partial pain relief, but persistent stiffness, swelling, and progressive hand deformity.

A 2025 review confirms HBOT offers temporary symptom relief in arthritis but does not alter disease progression.

Medical History

• Hypertension, well controlled
• Obesity (BMI 32)
• Former smoker (20 pack-year history; quit 10 years ago)

Family History:

• Mother with “crippling arthritis” requiring early hand surgery
• Sister with an autoimmune condition requiring long-term immunologic treatment

Mrs. R. expresses frustration and concern, stating:

“I’m doing everything I can, but I feel like my joints are getting worse instead of better.”

Family histories like this often point to genetic predispositions that recent genomic studies link to specific HLA variants.

Clinical Considerations for Analysis

At today’s visit, the provider notes visible swelling of the MCP and PIP joints bilaterally, reduced grip strength, and difficulty rising from a seated position due to knee stiffness. No prior inflammatory markers or autoimmune laboratory testing have been performed.

Page 2 of 4CASE STUDY QUESTIONS (RUBRIC-ALIGNED) – Thoughts to consider in your writings for the content – however, follow the entire rubric.

Rubric Criterion 1 – Primary Pathophysiological Processes (30 points)

Rubric language:

“Develop a case study analysis examining patient signs and symptoms. Discuss the primary pathophysiological processes and their significance for symptom development and diagnosis”

Question 1: Pathophysiology and Diagnosis

1. Describe the primary pathophysiological mechanisms of:
   1. Rheumatoid arthritis (RA)
   2. Osteoarthritis (OA)
2. Using the patient’s clinical presentation, explain how these mechanisms account for:
   1. Prolonged morning stiffness
   2. Symmetrical joint involvement
   3. Pain, swelling, and functional impairment
3. Based on the patient’s signs and symptoms, identify the most likely diagnosis and provide a clear, brief, evidence-based rationale.

Insights from 2024 transcriptome analyses highlight genetic correlations between RA and OA but distinct immune pathways.

Rubric Criterion 2 – Genetics and Risk Factors (30 points)

Rubric language:

“Describe the role genetic mutations play in the development of the disease and the risk factors that make the patient more susceptible”

Question 2: Genetics and Disease Susceptibility

1. Discuss the role of genetic predisposition in the development of rheumatoid arthritis.
2. Compare this genetic contribution to osteoarthritis.
3. Identify and explain patient-specific risk factors that increase susceptibility to the most likely diagnosis.

Recent 2025 genetic studies identify over 100 loci associated with RA, emphasizing HLA-DRB1’s role in susceptibility.

Rubric Criterion 3 – Racial/Ethnic Variables AND History/Lifestyle Factors (25 points total)

Rubric language:

“Explain any racial/ethnic variables that may impact physiological functioning AND explain factors in the patient’s history and lifestyle that could have contributed to the development of the disease process”

Question 3: Racial/Ethnic Considerations, History, and Lifestyle Factors

1. Explain how racial or ethnic variables may influence:
   1. Disease prevalence
   2. Severity and progression
   3. Physiological functioning
   4. Access to diagnosis or treatment
2. Analyze how the patient’s history and lifestyle are contributing factor to the disease development, symptoms progression and severity:
   1. Poor diet
   2. Obesity
   3. Vitamin supplementation
   4. Use of hyperbaric oxygen therapy (HBOT)
3. Clearly distinguish adjunctive symptom management strategies from disease-modifying treatment.

Data from 2024 U.S. surveys show higher RA prevalence in certain ethnic groups, influencing access to timely care.

IMPORTANT REMINDERS:

• This is a case-based analysis, not a textbook disease summary.
• Do not assume or create laboratory or imaging data.
• All discussion must be directly tied to the patient’s presentation.
• Avoid SOAP-note or charting language.
• Use primary, peer-reviewed literature to support all major claims.
• Supplements and HBOT should be discussed as adjunctive, not curative.
• Body of paper must not exceed 2 pages, per rubric or points will be deducted. Concise, synthesis-based writing is expected. Papers that exceed page limits due to general disease descriptions, TEXT BOOK STYLE WRITINGS, rather than case-focused analysis may lose points under written criteria
• Title page and reference list do not count toward page length.
• Papers exceeding page limits or relying on secondary sources will lose poi

Staying focused on the case helps ensure your analysis remains relevant and impactful.

Rubric:

Develop a 1-2 page case study analysis, examining the patient signs and symptoms presented in the case study. Discuss the primary pathophysiological processes and the significance for symptom development and diagnosis.

30 to >27.0 ptsExcellentThe response discusses the primary pathophysiological processes, and the significance for symptom development and diagnosis in detail. The pathophysiology is accurate and responses show in depth critical thinking.

27 to >24.0 ptsGoodThe response discusses the primary pathophysiological processes, significance for symptom development and the diagnosis in some detail. The pathophysiology is accurate and the responses show come critical thinking.

24 to >22.0 ptsFairThe response discusses the primary pathophysiological processes, significance for symptom development and diagnosis in a manner that is vague or inaccurate. The response is supported with explanations that are vague or based on inappropriate evidence or research.

22 to >0 ptsPoorThe response discusses the primary pathophysiological processes, the significance for symptom development and diagnosis in a manner that is vague and/or inaccurate or the description is missing. The response does not include rationales, has vague explanations or is based on inappropriate or no evidence or research.

30 pts

This criterion is linked to a Learning OutcomeDescribe the role genetic mutations play in the development of the disease and the risk factors that make the patient more susceptible to the disease.

30 to >27.0 ptsExcellentThe response includes an accurate, complete, detailed and specific analysis of the genes/risk factors that are associated with the development of the disease.

27 to >24.0 ptsGoodThe response includes an accurate analysis of the genetics and risk factors that may be associated with the development of the disease. Response does not fully address all factors.

24 to >22.0 ptsFairThe response includes a vague or inaccurate analysis of the genetics/risk factors that are associated with the development of the disease.

22 to >0 ptsPoorThe response includes a vague or inaccurate analysis of the genetics/risk factors that are associated with the disease and/or portions are missing.

30 pts

This criterion is linked to a Learning OutcomeExplain any racial/ethnic variables that may impact physiological functioning. Explain factors in the patient’s history and lifestyle that could have contributed to the development of the disease process.

25 to >22.0 ptsExcellentThe response includes an accurate, complete, detailed and specific explanation of racial/ethnic variables that may impact physiological functioning. Explain factors in the patient’s history and lifestyle that could have contributed to the development of the disease. Content is supported by evidence and/or research, as appropriate, to support the explanation.

22 to >19.0 ptsGoodThe response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning. Explains factors in the patient’s history and lifestyle that could have contributed to the development of the disease. Content is supported by evidence and/or research, as appropriate, to support the explanation.

19 to >17.0 ptsFairThe response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning. A vague or inaccurate explanation of factors in the patient’s history and lifestyle that could have contributed to the development of the disease and/or explanations based on inappropriate evidence/research.

17 to >0 ptsPoorThe response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning. A vague or inaccurate explanation of factors in the patient’s history and lifestyle that could have contributed to the development of the disease, or the explanations are based on inappropriate or no evidence/research.

25 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. Content is supported by at least 3 current evidence-based sources. Body of paper is no more than 2 pages in length.

5 to >4.0 ptsExcellentParagraphs and sentences follow writing standards for flow, continuity, and clarity. Content is supported by 3 current evidence-based sources which have been submitted with the assignment. Body of the paper is no more than 2 pages in length.

4 to >3.0 ptsGoodParagraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Some content is supported by 3 current evidence-based sources. Body of paper is no more than 2 pages.

3 to >2.0 ptsFairParagraphs and sentences follow writing standards for flow, continuity and clarity 60%-79% of the time. Some content is supported by at least 2 current evidence-based sources. Body of paper is longer than 2 pages.

2 to >0 ptsPoorParagraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time. No content is supported by current evidence-based sources.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.

4 to >3.0 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.

3 to >2.0 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.

2 to >0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

5 to >4.0 ptsExcellentUses correct APA format with no errors.

4 to >3.0 ptsGoodContains a few (1 or 2) APA format errors.

3 to >2.0 ptsFairContains several (3 or 4) APA format errors.

2 to >0 ptsPoorContains many (≥ 5) APA format errors.

5 pts

Total Points: 100

Mrs. Eleanor’s symmetrical swelling in hands and knees, along with prolonged morning stiffness, strongly suggests rheumatoid arthritis rather than osteoarthritis, as RA involves autoimmune synovial inflammation leading to these symptoms. Genetic predisposition, evident from her family history of autoimmune conditions, plays a key role in RA development through variants like HLA-DRB1 that increase susceptibility. Lifestyle factors such as obesity and poor diet may exacerbate progression by promoting systemic inflammation, while HBOT provides adjunctive relief but not disease modification. Evidence from peer-reviewed sources supports focusing on early intervention to improve outcomes in similar cases.

• Caliogna, L., Berni, M., Torriani, C., Mancuso, M.E., Di Minno, M.N.D., Brancato, A.M., Jannelli, E., Mosconi, M. and Pasta, G., 2024. Pathogenesis of osteoarthritis, rheumatoid arthritis, and hemophilic arthropathy: The role of angiogenesis. Haemophilia, 30(6). https://doi.org/10.1111/hae.15097
• Sharma, S.D., Leung, S.H. and Viatte, S., 2024. Genetics of rheumatoid arthritis. Best Practice & Research Clinical Rheumatology, 38(4). https://www.sciencedirect.com/science/article/pii/S1521694224000391
• Tang, S., Zhang, C., Oo, W.M., Fu, K., Risberg, M.A., Bierma-Zeinstra, S.M., Neogi, T., Atukorala, I., Malfait, A.M., Ding, C. and Hunter, D.J., 2025. Osteoarthritis. Nature Reviews Disease Primers. https://doi.org/10.1038/s41572-025-00594-6
• Zhang, Z., Shao, Z., Xu, Z. and Wang, J., 2024. Similarities and differences between osteoarthritis and rheumatoid arthritis: insights from Mendelian randomization and transcriptome analysis. Journal of Translational Medicine, 22(851). https://doi.org/10.1186/s12967-024-05643-4
• • How to analyze rheumatoid arthritis vs osteoarthritis in nursing case study assignments