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Original Question
CASE EXEMPLAR: Patient With Knee Pain Secondary to Osteoarthritis MP is a 70-year-old female who presents to the clinician’s office for a routine check-up. Her complaint at today’s visit is the pain in her knees secondary to osteoarthritis. Chronic pain is intermittent, but worse for the last 3 days after doing “a lot of yard work”. Pain is worse with climbing stairs or prolonged standing. She describes the pain as a 4 on a scale of 1 to 10. She has been using cold compresses on her knees every evening but has experienced little relief of her pain symptoms. She denies recent fall or trauma. Review of symptoms is otherwise unremarkable. Past Medical History • Gastroesophageal reflux disease • Hypertension • Osteoarthritis of knees and hands • Seasonal allergies • Atrial fibrillation • No known drug allergies Medications • Cetirizine, 10 mg once daily • Hydrochlorothiazide, 12.5 mg once daily • Ranitidine, 75 mg once nightly • Warfarin, 2.5 mg once daily (INR 2.7) • Sotalol, 80 mg twice daily • Multivitamin, once daily Social History • MP is a smoker, half a pack per day • Reports rare consumption of alcohol Physical Examination BP 134/68, P 72, R 14, T 98.8. Ht. 69 in., Wt. 150 lb. General: Well developed, well nourished, appears stated age and in no acute distress. Alert and oriented x 4. Skin: Warm and dry, no bruising, lacerations, or evidence of trauma. MSK: Heberden nodes observed on the DIP joints of the right 2nd and 3rd fingers and the left 2nd finger, with associated mild decrease in flexion of these joints. Bilateral knees – Mild crepitus with ROM bilaterally. Active ROM – 0 to 110 degrees right, 5 to 100 degrees left. No effusion, erythema, warmth, tenderness, joint line tenderness, signs of trauma. Labs • Within normal limits Assessment Bilateral knee osteoarthritis with acute exacerbation DISCUSSION QUESTIONS 1. Which health conditions may impact the over-the-counter (OTC) analgesic recommendation?. 2. Which OTC analgesic is recommended for MP, and how should MP be counseled to take this medication? 3. MP has also requested a topical agent to rub on her knees. What OTC product is recommended?
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