Diffuse pain related to osteoarthritis of the knees and hand

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Reference no: EM133764616

Question

A 72-year-old woman comes to the office for follow-up because she has persistent, diffuse pain related to osteoarthritis of the knees and hands, despite taking acetaminophen 1,000 mg three times daily. She walks 1-2 miles daily and gardens, but the pain has started to limit her activity. History includes: Well-controlled hypertension Hyperlipidemia Hypothyroidism Current medications (in addition to acetaminophen): Hydrochlorothiazide Atorvastatin Levothyroxine She avoids NSAIDs because they cause her dyspepsia and nausea. On physical examination there is joint line tenderness and bony enlargement of the proximal and distal interphalangeal joints of both hands and of the knees, as well as crepitus of the knees there is no synovitis In addition to acetaminophen, which of the following is the most appropriate next step for long-term pain management? Duloxetine 30 mg/d Glucosamine sulfate 1,500 mg/d Hydroxychloroquine 200 mg/d Oxycodone 5 mg four times daily.

Reference no: EM133764616

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