BOF: 2.36
A 60-year-old female presents with pain in her knees. The
pain increases after use and is relieved by rest. There are no systemic
symptoms.
On examination she is obese. On examination of the hands
there are Heberden’s nodes and Bouchard’s nodes. The knees show bony
swelling; there is localised joint and periarticular tenderness. The range of
movement is decreased and there is crepitus on movement.
Investigations show normal haematology and biochemistry
and inflammatory markers are not raised.
In this patient,
the pharmacological intervention of first choice should be treatment with:
a)
Paracetamol
b)
Codeine phosphate
c)
Non Steroidal Anti Inflammatory Drugs (NSAIDs)
d)
Tramadol
e)
Glucosamine sulphate
Answer:
a)
The clinical features suggest the patient has
osteoarthrosis. Paracetamol is the safest analgesics and is the recommended
oral agent of first choice in osteoarthrosis.
Codeine is useful in combination with paracetamol but
constipation and central nervous system disturbance may be a problem. NSAIDs
may be more effective than paracetamol but they are associated with renal and
gastrointestinal toxicity. Tramadol has more side effects. Glucosamine
sulphate is a nutritional supplement. In trials it has been shown to cause
modest reductions in pain and slows joint space narrowing in osteoarthrosis of
the knee.
Revision Tip
Revise osteoarthritis KEYS to
SUCCESS in Medicine page 496-498
