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Case Study: Chronic Inflammatory Osteoarthritis in a 58-Year-Old Female

Patient Profile:

  • Name: Mrs. Anne Johnson
  • Age: 58 years
  • Occupation: Office manager (sedentary work)
  • Past Medical History: Hypertension, hyperlipidemia, mild depression
  • Family History: Mother had osteoarthritis (OA), father had rheumatoid arthritis (RA)
  • Medications: Lisinopril 20 mg daily, atorvastatin 10 mg daily, sertraline 50 mg daily
  • Social History: Non-smoker, drinks wine occasionally, moderate exercise 2-3 times per week

Chief Complaint: Mrs. Johnson presents with a 2-year history of worsening bilateral knee pain, stiffness, and occasional swelling. She describes the pain as dull and aching, aggravated by prolonged standing or walking and relieved by rest. Over-the-counter NSAIDs provide partial relief, but the effect is diminishing.

History of Present Illness:

  • The pain started insidiously in both knees and has progressively worsened.
  • Morning stiffness lasts for about 30 minutes and improves with movement.
  • No history of trauma or significant injury to the knees.
  • Occasionally notices mild joint swelling, especially after a day of increased physical activity.
  • No systemic symptoms such as fever, weight loss, or fatigue.

Physical Examination:

  • BMI: 32 kg/m² (classified as obese)
  • Vital Signs: BP 138/86 mmHg, HR 78 bpm, RR 16/min
  • Bilateral knee examination shows:
    • Mild joint effusion in both knees
    • Tenderness on palpation along the medial joint lines
    • Crepitus during passive and active movement of both knees
    • Reduced range of motion, especially in flexion
    • Mild genu varum deformity (bow-legged appearance)
  • No signs of synovitis or warmth in the joints

Imaging: X-rays of both knees show joint space narrowing, particularly in the medial compartments, subchondral sclerosis, and osteophyte formation,

Diagnosis: Bilateral knee osteoarthritis

Treatment Considerations: Mrs. Johnson has tried weight loss and physical therapy without significant improvement. NSAIDs have been partially effective, but she expresses concern about their long-term use. She is interested in exploring other treatment options, including complementary and alternative therapies.

Questions for Case Assessment:

1. What key features in Mrs. Johnson's history and physical examination helped you confirm the diagnosis of osteoarthritis, and how do they differ from other types of arthritis?

2. What additional questions would you ask Mrs. Johnson to further assess for any inflammatory or systemic causes of her knee pain?

3. Given her concern about long-term NSAID use, what pharmacologic and non-pharmacologic treatment options would you consider for Mrs. Johnson’s osteoarthritis, and how would you prioritize them?

4. Discuss the role of complementary and alternative therapies for osteoarthritis. Which options would you recommend to Mrs. Johnson, and what evidence supports their use?

5. At what point would you consider referring Mrs. Johnson to an orthopedic joint replacement specialist for surgical intervention, and what factors would guide that decision?

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