++
“My right hip has really been bothering me recently”
+++
History of Present Illness
++
Marilynn Rush is a 64-year-old female with a past medical history of anxiety, obesity, and a gastrointestinal bleed 5 years ago, presenting with ongoing right hip pain that is impacting her daily life. She self-started a course of acetaminophen for 5 weeks without relief and is searching for additional work-up and evaluation to determine additional or alternative treatment options to help reduce her pain, improve her functioning, and improve her quality of life.
++
++
++
What evidence from the history and physical exam are consistent with a diagnosis of osteoarthritis in this patient?
Hint: See Epidemiology and Etiology, Pathophysiology, and Clinical Presentation and Diagnosis in PPP
What non-pharmacological therapies should be considered in this patient?
Hint: See Treatment and Figure 59-2 in PPP
Would you consider this patient a candidate for NSAID therapy? What factors would help differentiate choosing between a nonselective NSAID and a COX-2 inhibitor? What factors would you consider when selecting a dosage form (topical vs. oral)?
Hint: See Treatment, Table 59-1, and Figure 59-2 in PPP
Would you consider this patient to be a candidate for duloxetine? What factors would suggest a favorable patient response to duloxetine and what risks should the potential benefits be weighed against?
Hint: See Treatment in PPP
How effective is glucosamine/chondroitin for the treatment of OA? Would you recommend glucosamine/chondroitin for this patient?
Hint: See Treatment in PPP
++
How would you counsel the patient on the benefits and risks of intra-articular corticosteroids and hyaluronic acid?
++
Hint: See Treatment in PPP
++
Osteoarthritis is the most common rheumatic disease worldwide; however, the prevalence of OA varies widely across geographic regions. Prevalence rates in Europe approximate those in North America and generally do not exceed 10%. In contrast, the prevalence in developing regions can range from 3% to 20%. These differences are probably more closely associated with differences in populations than geographic location because the development of OA is not predicated solely on environmental factors. For example, when compared with North American Caucasians, Asians exhibit higher rates of symptomatic knee OA, but lower rates of hip and hand OA. This finding may be attributable to the higher proportion of rural farmers and hard laborers in many Asian regions than in North America. Thus, the prevalence of OA in any region reflects population differences in age, lifestyle, genetics, and ...