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Thursday, March 10, 2016

Treatment Options For A 78 year Old Woman With Pain In Her Knee Joint

A 78-year-old woman with mild renal insufficiency complains of pain in her knee joints on walking. The pain interferes with her day-to-day activities and is relieved by rest. There is no redness or swelling. There is minimal joint effusion.
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


2 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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  2. Nice blog
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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!
    Thanks so much for reading my article, you should share your testimony if you have cure as well
    Dr.akpupowerherbscenter@gmail.com
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