Reference no: EM133521940

Question

A 43-year old female presents for evaluation. Her left knee has been painful and swollen for the past week. Her symptoms have been worsening, and now she finds it difficult to bear weight. She denies any trauma or falls. She denies any other joint pain, and a review of systems is otherwise negative except for an annular rash that she had on the upper back about one month ago that resolved on its own. Past medical history and family history are unremarkable. On exam, her vital signs are normal. The left knee is erythematous, has an effusion, and is tender. The range of motion is limited in flexion and extension. The rest of the exam is normal. Laboratory evaluation shows a normal complete blood count, liver function, and renal function. Her erythrocyte sedimentation rate is 44 mm/hr. Rheumatoid factor, ANA, Anti-CCP are negative. Synovial fluid analysis reveals 12,000 white blood cells/mm3 and no crystals. Bacterial cultures are negative. An x-ray of the knee reveals mild medial joint space narrowing and the presence of an effusion. Magnetic resonance imaging (MRI) of the left knee reveals mild chondromalacia, a large effusion, and fraying of the medial meniscus without any significant tear. What is the next best step in the management of this case?