osteoarthritis real time case presentation

1. CASE
PRESENTATIO
N ON
BILATERAL OSTEO ARTHRITIES OF KNEE

2.  NAME - MR. X
 AGE - 62
 SEX - MALE
 DOA - 13/12/12
 IP NO - 96898

3. SUBJECT
REASON FOR ADMISSION :
 Bilateral knee joint pain (left > right).
 Bilateral pitting edema in both legs.
 Pain in the right hand index finger inter
pharangeal joints.
 Uncontrolled blood sugar levels
 Rash over the chest, swelling over the left
half of face following viral infection.

4. PMH : H/O hyper cholestremia.
H/O glaucoma in both the eyes .
C/O wheeze in the supine position when the
patient is
in bed.
FH : mother had diabetes .
brother had CAD , DM , HTN .
SH : none
ALLERGIES : none

5. GLUCOSE S/P 132
GLUCOSE S/P (P/P) 184
LDL S/P 136
MCV 98
MCH 33
ESR 38
CREATININE S/P 1.4
LAB
INVESTIGATIONS

6. DAY 1:
Pulse- 82/min
RR- 24
BP- 120/80
Temp- afebrile
Pain- 2/10
Ht-170
Wt-80kgs
BMI- 26
Cvs-S1S2 +
Chest/ Breast- lungs clear.
Abdomen – soft, BS +
Skin- hemifacial .
Neurological- consious
 x-ray of both the knees
joint line tenderness.
 paracetamol 650mg PO/BD
 Pantaprazole PO/ OD
 diclofenac diethyamine gel –TID
 Travoprost eye drops- 2 drops
in both eyes BD
 brimonidine eye drops – 1 drop
in both eyes in night .

7. Day 2:
 Vitals stable
 Gloucose tolerance
test
Day 3:
 Elevated sugar levels
 Physiotherapy for
knee
 Eye drops continued.
 Cocoa flex sachet –
PO/OD(antioxidant)
 T. diacerein- 50mg- BD
(Anti inflammatory agent)
 Metformin- 500mg PO/BD

8. Day 4:
Doppler leg(veins)
No elevated DVT.
ECG to be done
Day 5:
Day 6:
 Continue medications
 Synvisc (hylan G-F 20)
Injection for both knees
joints today.
 Total knee replacement
(surgery)

9. FINAL
DIAGNOSIS
• BILATERAL OSTEO
ARTHRITIES OF
KNEE

10. GOALS
 A) to educate the patient,caregivers, and relatives
 B) To re;ieve pain and stiffness
 C) To maintain and improve joint mobility
 D) To limit functional impairment
 E) To improve quality of life