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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Describe the most common signs and symptoms of osteoarthritis (OA).

  • Design an appropriate pharmacotherapeutic regimen for treating OA, taking into account a patient’s other medical problems and drug therapy.

  • Incorporate potential adjunctive therapies (pharmacologic, nonpharmacologic, and alternative) into the regimen of a patient with OA.

  • Assess and evaluate the efficacy of an analgesic regimen for a patient with OA, and formulate an alternative plan if the regimen is inadequate or causes unacceptable toxicity.

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PATIENT PRESENTATION

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Chief Complaint

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“What can I take to help this pain? This medication only takes the edge off!”

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HPI

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Ray Kansella is a 74-year-old man who comes in to see his PCP today complaining of right knee and right hip pain for the past 10 years since he retired from an assembly plant. He often did very heavy lifting in his job and put a lot of strain on his back and legs; now the patient feels he is paying the price for all of his hard work. Mr Kansella wakes up every morning very stiff, and his right knee cracks when he gets up out of bed. The cracking in the joint goes away after he finishes his breakfast, but the aching in his knee and hip persists and chronically bothers him. He has been taking Norco and Tylenol Extra Strength for the past several months on a scheduled basis with only minimal benefit. He reports not being sure of what medications he has tried in the past; all he knows is that whatever he is taking is not really helping. He reports adherence to all medications prescribed to him. His PCP is now asking for your recommendation on a pain management regimen for this patient given his past medical and medication history.

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PMH

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  • OA × 10 years

  • HTN × 20 years

  • Obesity × 15 years

  • Seizure disorder × 12 years (last seizure was 5 years ago)

  • CKD × 5 years

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PSH

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Appendectomy 35 years ago

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FH

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  • Father died at age 68 due to myocardial infarction

  • Mother died at age 81 of CVA

  • One brother (still living) with whom patient is not close

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SH

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  • Retired and has good insurance plan and a steady pension from his company

  • Denies tobacco use

  • Occasional EtOH (two to three beers on weekends)

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Meds

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  • Amlodipine 10 mg PO daily in AM

  • Lisinopril 10 mg PO daily in AM

  • Metoprolol 50 mg PO BID

  • Hydrocodone/APAP 7.5 mg/325 mg two tablets PO Q 6 H PRN pain

  • Acetaminophen 500 mg one tablet PO Q 6 H PRN pain

  • Levetiracetam 1000 mg PO BID

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All

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