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INTRODUCTION

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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

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PATIENT PRESENTATION

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Chief Complaint

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"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."

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History of Present Illness

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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.

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Past Medical History

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Hypertension × 7 years

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Hyperlipidemia × 5 years

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Insomnia × 8 months

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Diabetes mellitus type 2 × 4 years

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Obesity

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Family History

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Father died of MI at age 49.

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Social/Work History

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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.

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Tobacco/Alcohol/Substance Use

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Social drinker; (−) tobacco; 10 pack-year history, quit 18 years ago; (−) illicit drug use

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Allergy/Intolerance/Adverse Event History

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NKDA

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Medications (Current)

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Indapamide 2.5 mg PO once daily

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Lisinopril 20 mg PO twice daily

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Metformin/sitagliptin 1,000/50 mg PO twice daily

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Rosuvastatin 10 mg PO once daily

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Orlistat 60 mg PO 3 times daily with meals

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Zolpidem 10 mg PO once daily at bedtime

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Acetaminophen 1,000 mg ...

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