Osteoarthritis Case

Osteoarthritis Case In groups, review this patient case and come up with a management plan for patient SC. Part 1: Patient Information • • • Name: SC Age: 67 years Gender: Female Medical History • • • • • • Osteoarthritis of the right knee (diagnosed 2 years ago) Obesity Hypertension (HTN) Hyperlipidemia MI (3 years prior) DM Vitals on Presentation • • BMI: 32 kg/m² Blood Pressure: 112/74 mmHg Medications • • • • • Lisinopril 10 mg, one tablet daily Atorvastatin 20 mg, one tablet daily Aspirin 81 mg, one tablet daily Metformin 500 mg, one tablet twice daily Brilinta 60 mg, one tablet by mouth twice daily Social History • • • Retired schoolteacher Sedentary lifestyle with minimal regular exercise Lives alone, supportive family nearby Chief Complaint (CC): SC presents with persistent right knee pain accompanied by: • Morning stiffness • Difficulty performing daily activities (e.g., gardening and household chores) Assessment & Findings Symptom Review • • • Gradual increase in pain intensity over the past 6 months Morning stiffness lasting 20–30 minutes Occasional crepitus during movement Physical Exam • • Mild joint swelling and tenderness around the right knee Reduced range of motion and slight joint instability on weight-bearing Patient Self-Assessment • • Pain rated 6 - 7/10 on most days Activity limitation due to fear of worsening pain Questions: 1. Which characteristics observed in SC support a diagnosis of osteoarthritis? - Gradual onset of knee pain over six months. - Morning stiffness lasting <30 minutes (a hallmark of OA). - Crepitus during movement. - Mild joint swelling and tenderness. - Reduced range of motion and instability. - Activity limitation due to pain. 2. What primary non-pharmacological strategies are recommended for managing SC’s osteoarthritis? - Weight management (reducing joint load). - Exercise therapy (low-impact activities like swimming, cycling, and strength training). - Physical therapy improves mobility and strength. - Assistive devices (e.g., knee brace or cane for support). - Heat/cold therapy for pain relief. - Patient education about joint protection strategies. 3. How does weight reduction help in managing osteoarthritis symptoms? - Lessens mechanical stress on knee joints. - Reduces inflammation associated with excess adipose tissue. - Improves mobility and overall quality of life. 4. What role does a pharmacist play in the management of chronic osteoarthritis, as demonstrated in this case study? - Educating on medications, adherence, and side effects. - Recommending appropriate analgesics. - Ensuring safe medication use given comorbidities. Encouraging non-pharmacological approaches. Monitoring drug interactions with antihypertensives and anticoagulants. Part 2: Follow-Up Assessment Patient Information • • • Name: SC Age: 67 years Gender: Female Medical History • • • • • • Osteoarthritis of the right knee (diagnosed 2 years ago) Obesity Hypertension (HTN) Hyperlipidemia MI (3 years prior) DM Vitals on Presentation • • BMI: 31 kg/m² Blood Pressure: 117/79 mmHg Medications • • • • • Lisinopril 10 mg, one tablet daily Atorvastatin 20 mg, one tablet daily Aspirin 81 mg, one tablet daily Metformin 500 mg, one tablet twice daily Brilinta 60 mg, one tablet by mouth twice daily Patient Feedback: • • • Some improvement in mobility and slight weight reduction achieved Persistent moderate knee pain during joint-loading activities Concerns that non-pharmacological interventions alone are insufficient to control pain Review of Non-Pharmacological Interventions: • • Good compliance with exercise recommendations, yet breakthrough pain still occurs No adverse events noted with the lifestyle modifications Questions: 1. What pharmacological recommendations would you recommend for SC? - First-line: Acetaminophen (up to 3,000 mg/day, caution with liver disease). - If inadequate relief: Topical NSAIDs (e.g., diclofenac gel) to minimize systemic side effects. - If still insufficient: Low-dose oral NSAIDs (monitor for cardiovascular/GI risks). Adjunct: Duloxetine (if neuropathic pain component suspected) 2. What additional monitoring parameters should be considered when introducing pharmacological therapy for osteoarthritis in patients with comorbid conditions such as hypertension and hyperlipidemia? - Blood pressure (NSAIDs can elevate BP). - Renal function (NSAIDs can impair kidney function, especially with ACE inhibitors). - GI symptoms (NSAIDs increase ulcer risk, consider PPIs if needed). - Glucose levels (some analgesics may affect glycemic control in diabetes). 3. Why is acetaminophen chosen as the first-line pharmacological treatment in this case, and what is its maximum recommended daily dose? - Safer for patients with cardiovascular risks. Fewer GI and renal side effects than NSAIDs. Maximum dose: 3,000 mg/day (previously 4,000 mg/day but reduced due to liver toxicity concerns). 4. Compare the benefits and potential drawbacks of using topical NSAIDs versus oral NSAIDs in the management of osteoarthritis in older adults. - Topical NSAIDs: Lower systemic absorption, fewer GI and CV risks, effective for localized knee OA. - Oral NSAIDs: More potent pain relief but higher risks (GI ulcers, renal dysfunction, cardiovascular events). -