CASE LEARNING OBJECTIVES
Identify the risk factors associated with osteoarthritis (OA)
Recognize the signs and symptoms of OA
Formulate a nonpharmacologic plan for patients with OA
Recommend a pharmacologic plan for patients with OA that considers individual patient factors
Develop monitoring parameters to assess the effectiveness and adverse effects of pharmacotherapy for OA
Deliver effective disease-state counseling, including lifestyle modifications and drug therapy, to facilitate effective and safe management of OA
"My knees are starting to hurt more and more every time I climb stairs. I also fell last week at work because my right knee gave out."
History of Present Illness
Bryce Johnson is a 68-year-old white male who presents to his primary care physician complaining of increasing bilateral knee pain over the past 4 months with recent joint instability, most notably in the right knee. His knee pain is frequently associated with climbing stairs. He also reports knee stiffness on waking, which lasts approximately 15–20 minutes and abates with ambulation. He has not previously sought care for his knee pain. On "bad" days, he reports taking acetaminophen 1,000 mg 2–3 times daily. Although this dose is generally inadequate to fully alleviate his pain, he is concerned about taking larger doses because of the recent news coverage of acetaminophen-induced liver toxicity. He has also been trying to lose weight using an over-the-counter product containing orlistat. He reports poor compliance with this medication due to diarrhea on numerous occasions. Lastly, he requests your advice on taking a product that a family member recommended, called Cosamin DS. He has been told that it prevents joint breakdown and is safer than painkillers.
Diabetes mellitus type 2 × 4 years
Father died of MI at age 49.
Retired, former packaging plant floor manager for a mail-order company. Currently, a part-time volunteer for a local political campaign. Divorced; has 2 children, aged 35 and 37.
Social drinker; (−) tobacco; 10 pack-year history, quit 18 years ago; (−) illicit drug use
Allergy/Intolerance/Adverse Event History
Indapamide 2.5 mg PO once daily
Lisinopril 20 mg PO twice daily
Metformin/sitagliptin 1,000/50 mg PO twice daily
Rosuvastatin 10 mg PO once daily
Orlistat 60 mg PO 3 times daily with meals
Zolpidem 10 mg PO once daily at bedtime
Acetaminophen 1,000 mg ...