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CASE EXEMPLAR: Patient With Joint Stiffness PK is a 63-year-old male presenting for follow-up of chronic intermittent pains in his knees and ankles. He has worked as a carpenter for most of his adult life, although he has been more of a supervisor over the past few years. He has been using a variety of creams and lotions as well as hot baths to help with the pain. He does not like pills in general, but he might consider medications as long as he will not get addicted. Past Medical History • Actinic keratoses Medications • Acetaminophen, 500 mg once per day as needed for pain Physical Examination • Well-developed, well-nourished male in no distress • Lungs: few scattered wheezes • Heart: regular rate and rhythm • Bony hypertrophy surrounding the joints of the hands; knees with palpable osteophytes and no effusion Labs and Imaging • Complete blood count: normal • Sedimentation rate: normal • X-rays: mild-to-moderate degenerative changes in both hands, knees, and ankles, with significant joint space narrowing in left knee Discussion Questions 1. What class of drugs is considered the first drug of choice for PK’s symptoms? 2. Are there nonprescription options available as adjuncts? 3. What role would corticosteroids play in the treatment of PK’s osteoarthritis?

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