Posted: April 27th, 2023

Fifty-nine–year-old Ray is complaining of a nagging discomfort

Fifty-nine–year-old Ray is complaining of a nagging discomfort in his buttocks and hips. It started about 6 weeks ago and is now interfering with his sleep. Ray says that when he lies down, the discomfort gets worse, so he often gets up in the middle of the night to walk around to get relief. He also describes a sciatic-like pain that occurs intermittently but states, “it goes from one side to another” (Chapter 50, Learning Objectives 2, 5, 6).

How is the inflammatory response associated with this skeletal disorder?
If Ray starts to complain of similar symptoms in other joints, what will you need to consider?
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Ray's symptoms suggest he may be experiencing inflammatory joint disease. According to Huether and McCance (2021), inflammatory joint diseases, such as rheumatoid arthritis, involve an inflammatory response in the synovial membrane. The synovial membrane lines the joint capsule and secretes synovial fluid, which lubricates the joint and provides nutrients to the cartilage. In inflammatory joint diseases, the synovial membrane becomes inflamed, leading to the production of cytokines and other inflammatory mediators. This results in synovial thickening and increased synovial fluid production, causing joint swelling, pain, and stiffness.

Ray's sciatic-like pain suggests that he may also have nerve involvement. This could be caused by pressure on the sciatic nerve from inflammation or swelling in the hip or buttocks region. If Ray starts to complain of similar symptoms in other joints, healthcare providers will need to consider whether he has a systemic inflammatory condition, such as rheumatoid arthritis, or whether he has multiple localized joint problems. If he does have a systemic inflammatory condition, it is important to identify it early and initiate appropriate treatment to prevent joint damage and disability.

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