Chapter 65 Case Study OA Case Study 47-year-old male presents to a clinic complaining of pain in his right knee with

activity Negative history for illnesses or trauma He used to play soccer regularly but has not played in 10 years He claims the pain prevents him from playing football with his teenage son No swelling of the knee is noted, but crepitation is present MRI is ordered It shows articulation of femur and tibia His physician prescribes rest for his knee with a follow-up in 3 months

V. Castellanos, SN

Discussion Questions 1. He asks you what he can take for pain relief over the next 3 months. What can you tell him? Acetaminophen (1000 mg every 6 hours as needed along with the patient can also use OTC Topical agent (e.g., BenGay, ArthriCare, capsaicin cream [Zostrix]) other topical are salicylates (e.g., Aspercreme). If a patient has not achieved satisfactory pain management with acetaminophen they can use NSAIDS. OTC ibuprofen (Motrin) 200mg up to four times daily, though the patient is at risk for GI side effects. Hyaluronic acid (HA) is another OTC viscosupplementation that can be added to other supplements like glucosamine and chondroitin. 2. What alternative therapies may benefit him? Rest and Joint Protection, patient must understand importance of balancing rest and activity During any periods of acute inflammation, affected joint should be rested also maintained in a functional position with splints or braces if necessary; Immobilization should not exceed 1 week Heat and Cold Applications may help reduce pain and stiffness. Heat is used more often than ice. Ice is appropriate for acute inflammation and heat therapy is especially helpful for stiffness. Examples of heat would be hot packs, whirlpool baths, ultrasound, and paraffin wax baths. Also we could include nutritional therapy and exercise for the patient. Teaching weight-reduction program is critical for overweight patient and exercise is a fundamental part of OA management The alternative therapies available would include acupuncture, yoga, massage, guided imagery, therapeutic touch, and nutritional supplements (glucosamine, chondroitin sulfate, Hyaluronic Acid) 3. What patient teaching should you perform with him? I would start with information about nature and treatment of disease and pain management strategies for optimal functioning. Also use of correct posture and body mechanics and assistive devices for to promote safety and mobility. Teach the principles of joint protection and energy conservation to not exacerbate condition. Give examples of nutritional choices, weight and stress management. Advise of available therapeutic exercise programs the patient can attend. Assure the patient that deformity is not usual course of OA. Get family members and significant others involved in goal setting and teaching. Instruct patient on home and work environments should be modified to maximize safety, e.g. remove scatter rugs, provide railing at stairs and bathtub, use of nightlights, use of assistive devices such as cane and walker, and wear well fitted support shoes. 4. What type of physical activity is advisable for him? The physician prescribed rest of the knee but aerobic conditioning and specific programs for muscle strengthening have led to modest reduction in pain and disability for some patients with knee OA.