An x-ray of the knee shows osteophytes and asymmetric loss of joint space and is shown below:
ESR and white blood cell count are normal.
Which of the following is the best initial management of this patient?
A. Naproxen
B. Indomethacin
C. Intra-articular corticosteroids
D. Acetaminophen
E. Total arthroplasty
Answer And Discussion:
The answer is D. (Acetaminophen.)
This patient has osteoarthritis. In addition to physical therapy, the best symptomatic treatment would be acetaminophen because it is frequently effective in providing pain relief and has an excellent safety profile in the elderly. Nonsteroidals should be avoided, at least initially, because they tend to cause gastrointestinal upset and impairment of renal function. Indomethacin is relatively contraindicated in the elderly because of its long half-life and central nervous system side effects.
Intraarticular steroids are indicated for large effusions in joints unresponsive to first-line therapy. Arthroplasty is highly effective in treating osteoarthritis of a single joint and is not contraindicated in the elderly. Such surgery is usuallyconsidered if attempts at physical therapy, education, and pain control with pharmacotherapy do not provide adequate symptom relief
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I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
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