Mrs. J, a 56-year-old female, presented with complaints of pain in her right hip and both knees. She was diagnosed with osteoarthritis in both knees. She underwent a bone marrow aspirate concentrate (BMAC) injection in both knees, which provided a natural alternative to surgery. Her hypertension was managed with nefidipine and amiloride/hydrochlorothiazide. She was discharged in a stable condition with recommendations for pain medication, diet and lifestyle modifications, and continued management of her osteoarthritis and hypertension.

1. Case presentation on
Osteoarthritis
Presented by
R.Anusha
Pharm D 5 th year
Roll no : 07
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2. Patient name: Mrs. J
Gender: Female
Age: 56 years
IP no: 282115
DOA:18/9/2018
DOD: 21/9/2018
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3.  Chief Complaints: Complaints of pain in right hip and both knees
 Past Illness History: Past history of revision THR right side.
Knee pains-gradually progressive. No H/o Trauma.
 Past Medical History: K/c/o HTN – On medication.
 Past Medication History:
T. NEFIDIPINE 30mg PO OD
T.AMILORID(Amiloride 5mg+Hydrochlorthiazide 50mg) OD
 ALLERGY: Allergy to blood transfusion.
SUBJECTIVE
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4. OBJECTIVE
Vitals:
Temperature: Normal
Pulse rate:86/min
Respiratory rate:20/min
Blood pressure:130/80 mm of Hg
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Physical appearance:
• Height:158cms
• Weight:88.6kgs
• BMI:35Kg/m2

5. Lab investigations:
CBP:WNL
CUE:WNL
ECG:WNL
ESR:28(0-28mm/hr)
CRP:3.59(< 3 mg/L)
FINAL DIAGNOSIS:
Osteoarthritis both knees
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6. Procedure: BMAC injection was given to both knees.
Drug chart
BRAND GENERIC DOSE FRE
Q.
RO
A
CATEGORY INDICATION
T.NEFIDIPINE Nefidipine 30mg OD PO CCB HTN
T.AMILORID Amiloride
Hydrochlor
thiazide
5mg,
50mg
OD PO K+ Sparing
agent,
Thiazide
diuretic
HTN
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7. GOALS OF THE THERAPY
 To educate the patient and family members.
 To relieve pain and stiffness
 To maintain or improve joint mobility
 To limit functional impairment and
 to maintain or improve quality of life
 To maintain a blood pressure of below 140/80 mm Hg (K/C/O HTN)
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8. ASSESMENT
• A 54YOF, Mrs. J came with complaint of pain in right hip and both
knees. Knee pain gradually progressive.
• On evaluation patient was diagnosed with K/C/O OSTHEO ARTHRITIS
both knees.
• Patient has past H/o right revision TOTAL HIP REPLACEMENT (long
stem with trochanteric wiring) 4 times , which is usually done when all
other treatment options have failed to provide adequate pain relief.
• Bone scan of right hip done-Scan negative for loosening or infective
pathology involving the right hip prothesis.
So, now patient may need injection BONE MARROW ASPIRATE
CONCENTRATE to both knees which is natural alternative to surgical
intervention.
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9. Bone Marrow Concentrate(BMC) Therapy, also known as Bone Marrow
Aspirate Concentrate(BMAC) Therapy, is a promising non surgical
regenerative therapy to accelerate healing in severe osteoarthritis.
The bone marrow contains a reservoir of “pluripotent” stem cells that
can be withdrawn from the patient’s hip bone and used for the procedure.
With BMC, the concentrate of regenerative cells provides a more robust
healing of the damaged tissue and aids in growth and repair by
accelerating the body’s natural healing mechanism.
BMAC was done to both knees and post BMAC was uneventful.
• Patient was a known case of hypertension and
T.AMILORID(Amiloride 5mg+Hydrochlorthiazide 50mg) OD was
continued in hospital.
A thiazide is the preferred type of diuretic for hypertension and is
considered a first-line therapy option in most patients with
hypertension.
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10. Hydrochlorothiazide is a “thiazide-type” agent;usual dose is 12.5-50
mg/day.
Potassium sparing agents(Amiloride) are used only in conjunction with
a thiazide diuretic to prevent K+ loss and to augment the
antihypertensive action.
T. NEFIDIPINE 30mg PO OD was continued in hospital.
A long-acting dihydropyridine CCB should be strongly considered as
preferred add-on therapy when a thiazide is not controlling BP in a
patient and no other compelling indications.
Nifedipine usual dose is 30-90 mg/day OD.
It reduces CV morbidity and mortality as add on therapy with thiazide
diuretic.
• Patient was discharged in heamo-dynamically stable condition.
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11. PLAN
Monitoring parameters:
Disease related
• Post-injection soreness at the injection site is some times present because
of an inflammatory response caused by BMC therapy.
• Monitor Blood pressure.
Drug related
• BIDURET(Amiloride + Hydrochlorothiazide):Monitor Potassium levels.
RECOMMENDATIONS:
Pain killers like Tramadol should be given to control the pain.
DVT prophylaxis is must because patient is obese in this case.
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12. Patient counselling:
DISEASE RELATED:
• For the first 2-7 days, swelling and discomfort are typical in the injected
area. By the end of the first week, these symptoms usually begin to
resolve.
• Most patients notice some level of improvement by 2-6 weeks
following BMC. Increased stability and strength are typically reported
along with the decrease in pain.
• A second level of benefits may be obtained between 6 weeks and 3
months.
• It is important that anti inflammatory medications such as Ibuprofen,
Naproxen and Aspirin should be avoided following treatment because
these medicines may block the effects of the intended healing response
facilitated by the post injection inflammation.
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13. DRUG RELATED
• OSTEOARTH 2g(Nutritional supplement-Chondroitin sulfate,Collagen
peptide,Curcumin,Ginger extract,Glucosamine,Piperine,Vitamin C ) to
be taken twice daily orally after food for 6 months.(given for
osteoarthritis)
• BIDURET 50mg(Amiloride 5mg + Hydrocholorothiazide 50mg) 1 tab
to be taken once daily orally after food.(continue it for hypertension).
• NICARDIA RETARD 20mg (Nifedipine 20mg) 1 tab to be taken once
daily orally after food.(continue it for hypertension).
• NICARDIA RETARD 10mg (Nifedipine 10mg) 1 tab to be taken orally
once daily orally after food.(continue it for hypertension).
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14. Life style modifications
• Maintain normal body weight - body mass index 18.5-24.9 kg/m2
• Consume a diet rich in fruits, vegetables, and low-fat dairy products with
a reduced content of saturated and total fat.
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