Which description is most characteristic of osteoarthritis (OA) when compared to rheumatoid arthritis (RA)?

Choice A reason: Nonrestorative sleep with fatigue is a core fibromyalgia symptom, alongside widespread pain. Disrupted sleep architecture, including reduced deep sleep, exacerbates pain sensitivity and fatigue, driven by central nervous system dysregulation. Recognizing this guides management with sleep hygiene, medications like amitriptyline, and exercise to improve sleep quality and reduce fatigue.

Choice B reason: Fibromyalgia does not involve inflammation or fever, unlike rheumatoid arthritis. It’s a noninflammatory pain syndrome with central sensitization. Expecting inflammation or fever misdiagnoses fibromyalgia, potentially leading to inappropriate treatments like corticosteroids, which are ineffective, delaying proper care with antidepressants or physical therapy for pain and fatigue.

Choice C reason: Generalized muscle twitching and spasms are not typical fibromyalgia symptoms. These suggest neurological conditions like myoclonus or electrolyte imbalances. Fibromyalgia involves diffuse pain and tenderness, not spasms. Assuming twitching misguides assessment, risking incorrect interventions and overlooking fibromyalgia’s core symptoms like sleep disturbance and fatigue.

Choice D reason: Profound muscle weakness limiting ADLs is characteristic of neuromuscular diseases like myasthenia gravis, not fibromyalgia. Fibromyalgia causes pain and fatigue, not progressive weakness. Expecting weakness misdirects diagnosis, potentially leading to unnecessary neurological testing, delaying fibromyalgia management with exercise, cognitive therapy, and medications to address pain and fatigue.

Choice A reason: Applying heat for 10 minutes every hour is insufficient to relieve back strain and may not prevent recurrent pain. Heat therapy requires 15-20 minutes to relax muscles and improve blood flow effectively. This strategy is not a primary recommendation, as it does not address posture, movement, or ergonomic factors critical for back health.

Choice B reason: Padded shoe insoles absorb shock and support proper foot alignment, reducing stress on the spine during standing or walking. By improving biomechanics, insoles help distribute weight evenly, minimizing strain on the lower back. This is a practical strategy for nurses who stand for long periods, preventing repetitive back pain episodes.

Choice C reason: Sleeping on a soft mattress exacerbates back pain by failing to support spinal alignment, causing excessive curvature. A medium-firm mattress maintains neutral spine position, reducing strain on lumbar muscles and ligaments. This strategy is incorrect, as it does not contribute to minimizing back strain or preventing pain.

Choice D reason: Avoiding prolonged sitting reduces pressure on lumbar discs and prevents muscle stiffness. Prolonged sitting compresses spinal structures, weakening core muscles and increasing strain. Regular movement or standing breaks improve circulation and maintain flexibility, making this a key strategy to prevent recurrent low back pain in workplace settings.

Choice E reason: Sleeping in a side-lying position with flexed knees aligns the spine and reduces lumbar strain. This position, often supported by a pillow between the knees, maintains neutral pelvic alignment, minimizing stress on spinal ligaments and discs. It is an effective strategy for preventing back pain during rest, promoting recovery.