Osteoarthritis is a common condition that is typically associated with older adults. Other causes of osteoarthritis, such as those cases resulting from childhood Perthes disease, can affect younger people and frequently have a major impact on the lives of those affected. This case report describes the experiences of one patient with osteoarthritis, using examples of her poetry to illustrate her social, psychological and emotional transformation

AW Frank

Christian D Mallen

D Hatem

F Sampson

Helen S Burrell

Jane C Richardson

M Bury

English

PubMed

Springer - Publisher Connector

A woman living with osteoarthritis: a case report

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A woman living with osteoarthritis: A case report

Richardson, JC

Mallen, CD

Burrell, HS

Name not available

A woman living with osteoarthritis: A case report.

BioMed CentralCases Journal
ssOpen AcceCase Report
A woman living with osteoarthritis: A case report
Jane C Richardson*1, Christian D Mallen1,2 and Helen S Burrell1
Address: 1Arthritis Research Campaign National Primary Care Centre, Keele University, Keele, Staffs, ST5 5BG and 2Kingsbridge Medical Practice, 
Kingsbridge Avenue, Clayton, Newcastle-under-Lyme, Staffordshire, ST5 3BR
Email: Jane C Richardson* - j.c.richardson@keele.ac.uk; Christian D Mallen - c.d.mallen@cphc.keele.ac.uk; 
Helen S Burrell - j.c.richardson@keel.ac.uk
* Corresponding author    
Abstract
Osteoarthritis is a common condition that is typically associated with older adults. Other causes
of osteoarthritis, such as those cases resulting from childhood Perthes disease, can affect younger
people and frequently have a major impact on the lives of those affected. This case report describes
the experiences of one patient with osteoarthritis, using examples of her poetry to illustrate her
social, psychological and emotional transformation.
Introduction
Osteoarthritis (OA) is the most common joint disease and
one of the most widespread of all chronic conditions
managed in general practice. Whilst the prevalence of OA
increases with age, a significant minority of adults experi-
ence symptoms earlier in life. Most cases of osteoarthritis
are not extraordinary, yet the individual experiences of
those affected provide a unique opportunity for health
care practitioners and researchers to more fully under-
stand the impact that common conditions have on their
patients.
This case report was triggered by a patient (HB) wanting
to tell her story. The importance of narrative in medicine
is increasingly being recognised as a powerful tool that
can strengthen clinical practice and help to create an alli-
ance with patients. This alternative case report, written by
a researcher (JCR), a general practitioner (CDM) and a
patient (HB), presents a fairly typical case of a younger
adult with osteoarthritis. However, rather than presenting
laboratory results or X-ray findings, we use Helen's poems
to highlight her experiences and her journey with osteoar-
thritis.
Case presentation
Helen is 46 years old and has generalised osteoarthritis.
Her hips and hands are the most severely affected joints.
Helen's health problems started at the age of 11, following
a fall on a cross-country run. She consulted her general
practitioner and the accident unit multiple times with
increasing levels of pain and disability before she was
eventually diagnosed with Perthes disease, a diagnosis
that has had a huge impact on her subsequent life. Over
the years Helen has tried the full range of pain medica-
tions. A review of her past prescriptions reveals trials of
over 15 different analgesics and anti-inflammatory drugs,
covering the full range of the analgesic ladder. Her current
medication, oxycodone, has so far been the best choice,
optimising pain relief whilst minimising side effects.
Helen continues to be under the care of local orthopaedic
surgeons, who are contemplating further revisions to her
failed total hip replacement. Helen remains independent
and self-caring despite deterioration in her levels of pain
and physical functioning.
Helen trained as a radiographer, but following the failure
of a hip replacement she became a wheelchair user, which
Published: 16 September 2008
Cases Journal 2008, 1:153 doi:10.1186/1757-1626-1-153
Received: 12 August 2008
Accepted: 16 September 2008
This article is available from: http://www.casesjournal.com/content/1/1/153
© 2008 Richardson et al; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 4
(page number not for citation purposes)
Cases Journal 2008, 1:153 http://www.casesjournal.com/content/1/1/153was not felt to be compatible with her job. This loss has
had significant impact on Helen's identity: she describes it
as being 'picked up from one life, where I could focus on me
and what I wanted to happen, and put in another, where some-
one else was in control'. The issues of identity and social
roles are key for Helen, in knowing how to define herself
– 'Am I disabled? a woman? a disabled woman? a carer?' –
and in the huge loss of identity caused by loss of her job,
associated financial security and her increasing disabili-
ties. This meant radical changes to her social life, inde-
pendence, choices, freedom of movement, interests and
hobbies.
The nature of Helen's condition does not mean she has
necessarily lost all other social roles. Helen's parents live
close to her and suffer from a number of physical and
mental health conditions. For Helen, being her parents'
main carer is a source of positive identity and pride,
although it also means she can be called to provide phys-
ical or emotional help at any time during the day or night.
Her father's illness also meant that Helen took on some of
his caring responsibilities, in looking after her elderly aunt
who had dementia.
Relationships and friendships have been very important
to Helen and have been affected by her condition. She had
been engaged at age 21, shortly before a period of hospi-
talisation. The relationship ended, she felt, because of her
depression during this period and her fiancé's lack of
experience of dealing with such a situation. She describes
the problems with actually meeting people with whom to
have a relationship, but also the dilemma and difficulty of
attempting to "build an equal partnership, when somebody
does have to take on a carer's role." She also describes con-
flict in relationships with people who had had disabilities
since birth, both from their perspective, and from expec-
tations of other people who thought she 'should' have a
relationship with a non-disabled person.
Helen describes the process of learning "to become disa-
bled." An event she found helpful in this process was a dis-
ability awareness training course, because, "you're put into
this situation but you don't get given a tablet to make you be
disabled, ...to understand being disabled and impaired and 'all
the rest of it"." This enabled her to write her own disability
awareness course, including issues that were important to
her as a woman and as a person who had acquired her dis-
abilities.
Helen's relationship with her GP (CDM) is important to
her, particularly as he is also her parents' GP and therefore
has an understanding of the context in which she is man-
aging her disability. She also feels strongly about the ben-
efits of having a relationship with her GP in which she is
seen as a person and is able to "be herself", without being
concerned that she is seen as a problem or that people are
worrying about her.
Discussion
We have presented a case of a woman with osteoarthritis
secondary to Perthes disease in childhood. We have
described her emotional, social and psychological trans-
formation using her poetry to illustrate different life expe-
riences. The notion of biographical disruption[1] can be
used to describe the identity changes experienced by
Helen. This 'breaking down' of one's life is eloquently
described by Arthur Frank, a medical sociologist who has
himself experienced critical illness: "What happens when
my body breaks down happens not just to that body but also to
my life, which is lived in that body. When the body breaks
down, so does the life. Even when medicine can fix the body,
that doesn't always put the life back together again." [2] One
response to biographical disruption is to attempt to repair
the narrative of one's life[3]. Creativity, through poetry,
writing or art, can be seen as one way of trying to make
sense of this disruption. This type of creativity may be
actively encouraged as part of a healing process [4-6],
although Helen's poems were originally written solely for
and by herself.
This is not a traditional case report, yet we believe that our
approach can be equally as informative, by allowing doc-
tors and researchers to more fully understand the impact
a disease has on all aspects of their patient's lives.
Patient's perspective
Where have I gone?
Where's the woman who weighed less than 9 stone?
Who wore a dress size 12 and didn't need to wear shapeless
clothes or jogging suits?
Who had shaped and tidy eyebrows that would complement her
latest hair colour and style?
Whose painted nails, with manicured hands and feet, were per-
fect for holidays in the sun?
Where's the woman who had a vocation not just a job, but who
exists on benefits, a step away from poverty?
Where's the woman who owned her own home that gave her
safety and privacy, it was her pride and joy?"
Where's the woman whose hobbies include travel, gardening,
decorating, furniture restoring, sewing, reading and studying at
home?Page 2 of 4
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Cases Journal 2008, 1:153 http://www.casesjournal.com/content/1/1/153Here I am and life before my impairment has gone, the only
thing I can do is hold a pen with a special grip and writing is
agony.
Where has she gone?
Where has she gone?
WHERE HAVE I GONE?
Do you see me?
How can you ever know me, when all you see is my chair?
My limitations are all you see and you say they complicate your
life.
Will you ever see the deep pools of love in my eyes for you?
When you half close yours with pity and turn away from me.
The beating of my heart in expectation of your closeness is
quickly cooled by your fleeting hug or, worse, patting my shoul-
der.
I wait in anticipation remembering the taste and softness of
your kiss, you offer me a warm 'peck' on the cheek.
I smell your aftershave ... you say I smell clean!
I remember running my fingers through your hair,
Ripping buttons off your shirt but that's difficult when you
stand behind me pushing my chair, we can't even hold hands
anymore.
The power of my emotions makes me feel strong,
Then I catch that pitying look in your eye,
They die in my heart.
I do not speak, my smile fills my face but you will never know ...
You'll never see the real woman who is me
Who sits and is seen by the world framed by a wheelchair
Cut off emotionally just because I cannot stand or walk.
Thank you
Thank you to those who take the time to listen to difficult and
unclear speech, for you help us to know that if we persevere we
can be understood
Thank you to those who walk with us in public places, ignoring
stares and whispers from strangers, for in your friendship we
find enjoyment, laughter and happiness
Thank you for never asking us to 'hurry up', but even more spe-
cial is you don't snatch our tasks from us or offer 'Care' in such
a way as to make us feel that we are still children, with no con-
trol and respect
Thank you for standing beside us when we enter new experi-
ences and try new adventures
Though our success may be outweighed by our failure, the expe-
rience will stay with us forever and there will be many occasions
when we surprise ourselves and maybe even you!
Thank you for asking for our help and expertise,
As self-confidence and awareness come from being needed by
you and others
Thank you for giving us respect
You acknowledge our value as experts in our fields and that we
require to live with equality in society
We shouldn't have to ask or have laws to enforce it or remind
you
Thank you for assuring us that the things that make us individ-
uals are not our medical impairments, as everyone has those
and they don't define ONE'S SELF, it's people's attitudes that
create barriers that exclude us from you.
Treat us as we treat you.
Consent
Written informed consent was obtained from the patient
for publication of this case report and accompanying
images. A copy of the written consent is available for
review by the Editor-in-Chief of this journal.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
"JCR interviewed HSB and wrote the article based on the
interviews. CDM wrote the medical aspects of the article
and helped with the drafting of the article. HSB wrote the
patient perspective section. HSB and CDM helped revise
the manuscript".Page 3 of 4
(page number not for citation purposes)
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References
1. Bury M: Chronic illness as biographical disruption.  Sociology of
Health & Illness 1982, 4:167-182.
2. Frank AW: At the will of the body.  Houghton Mifflin; 1992. 
3. Frank AW: The Wounded Storyteller.  In Explore (NY) Volume 1.
Issue 2 Chicago: Chicago University Press; 2005:142-143. 
4. http://www.lapidus.org.uk: aims to promote the use of crea-
tive writing for health and wellbeing.  .
5. Sampson F: The Healing Word. The Poetry Society.  1999.
6. Hatem D, Rider EA: Sharing stories: narrative medicine in an
evidence-based world.  Patient Educ Couns 2004, 54(3):251-253.Page 4 of 4
(page number not for citation purposes)


At the will of the body.

Chronic illness as biographical disruption.

http://www.lapidus.org.uk: aims to promote the use of creative writing for health and wellbeing.

Rider EA: Sharing stories: narrative medicine in an evidence-based world. Patient Educ Couns

The Healing Word.

The Wounded Storyteller.

http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.278.2452

A woman living with osteoarthritis: A case report

Abstract

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