Mrs J was referred to the Pain service by her GP. She was 64 years old and had a three-year history of pain in both knees. The pain came on gradually and steadily worsened. Her left knee had always been more painful than her right. Over the past 6 months, she had been struggling to walk outside the house. If she had to do so, she used a walking stick and needed her daughter to accompany her. She scored the pain as 9 out of 10 on a verbal rating scale when walking or doing housework and 4 out of 10 when resting. She was frustrated that she could no longer manage the housework by herself and had put on weight as she spent most of her day sitting in her armchair.
She was taking 1g paracetamol QDS and using ibuprofen gel TDS but she did not think that these helped. Her GP arranged x-rays of both knees. The right knee x-ray showed mild tri-compartmental osteoarthritis with a small joint effusion. The left knee x-ray showed mild degenerative changes.
Before continuing, consider the following questions:
- Is there any other information you would like to know?
- What are the potential differential diagnoses?
- Are there further investigations that would be helpful?
- Would this patient benefit from evaluation by another specialty?
