A 40-year-old male patient presented with neck pain radiating to the upper limb, foot edema, and swelling in the left wrist for 2 years. Examination found increased blood pressure and blood sugar. He was assessed with left hand osteoarthritis. He was prescribed chondroin sulfate, B-complex, pregabalin, ciprofloxacin, and paracetamol. Lifestyle modifications including exercise, diet, weight control, and medication adherence were counselled.

1. CASE STUDY ON
OSTEOARTHRITIS
BY:
SWARNA PRIYA B
PHARM D

2. SOAP NOTES:
SUBJECTIVE:
A 40 years old male patient was admitted to the hospital with the chief
complaints of neck pain radiating to the upper limb, foot edema, and unusual
growth and swelling in left wrist for past 2 years.

3. OBJECTIVE
There are no similar complaint before . Known case of Diabetes Mellitus and on
regular diagnosis . And know case of bronchial asthma and not on regular diagnosis
.
The patient is complaint . On his physical examination the patient was found to be
conscious , afebrile and oriented and vitals revealed severe edema , increased blood
pressure . His blood investigation revealed increased blood sugar level . His urine
investigation revealed increased sugar content in urine . The patient is on mixed
diet and has decreased sleep with moderate stress and appetite and bowel and
bladder habits were seems to be normal.

4. LAB INVESTIGATIONS
SNO PARAMETRS SUBJECT
VALUE
REFERENCE
VALUE
INFERENCE
1. Blood pressure 130/90
mmhg
120/80
mmhg
Increased
2. Blood sugar
FBS
PPBS
219mg/dl
320mg/dl
70-110mg/dl
80-140mg/dl
Increased
Increased

5. ASSESMENT
The patient was assessed with “Left hand accessory ossicle with secondary
osteoarthritis of carpal bones. Osteoarthritis (OA) is a type of joint disease that
results from breakdown of joint cartilage and underlying bone. The most common
symptoms are joint pain and stiffness . Causes include previous joint injury, abnormal
joint or limb development, and inherited factors. degeneration of joint cartilage and
the underlying bone, most common from middle age onward. It causes pain and
stiffness, especially in the hip, knee, and thumb joints. bone death (osteonecrosis)
stress fractures. bleeding or infection in your joint. Deterioration of tendons and
ligaments around joints. pinched nerve, in OA of the spine. bone death
(osteonecrosis) stress fractures. bleeding or infection in your joint.

6. PLAN:
Procedure done: Excision and biopsy of mass from left
hand
SNO GENERIC
NAME
BRAND
NAME
INDICATION DOSE ROA FREQUENCY
1. Chondroino
Sodium sulfate
T-Tendo
care
Antirheumatic Mixed
dose
Oral 1-0-1
2. L-Methyl folate
pyridoxamine
B-complex Vitamin supplement 75mg oral 1-0-1
3. Pregabalin Pregaba Anti-convulsant 75mg Oral 1-0-1
4. Inj. Cifran Cipro
floxacin
Antibiotic 20mg IM 1-0-1
5. Paracetamol Para Analgesic 500mg Oral 1-1-1

7. INTERVENTION:
Patient has high blood sugar it cant be controlled by drugs.
Insulin Supplements must be prescribed in order to control blood sugar.
Increased blood sugar cases organ damage .
 B-complex suggested in morning because of disrupted sleep due to
stimulation of neurological activity. Morning dose with meals is
recommended.
 Serum amylase, serum lipase, CBC, liver function test and renal function has not
taken yet to detect any other abnormal conditions are there in liver and the kidney.
 Blood pressure was also high and no treatment was given .

8. DISCUSSION:
A 40 years old male patient was admitted to the hospital with the chief
complaints of neck pain radiating to the upper limb, foot edema, and unusual growth
and swelling in left wrist for past 2 years. There are no similar complaint before .
Known case of Diabetes Mellitus and on regular diagnosis . And know case of
bronchial asthma and not on regular diagnosis .The patient is complaint . On his
physical examination the patient was found to be conscious , afebrile and oriented and
vitals revealed severe edema , increased blood pressure . His blood investigation
revealed increased blood sugar level . His urine investigation revealed increased sugar
content in urine . The patient is on mixed diet and has decreased sleep with moderate
stress and appetite and bowel and bladder habits were seems to be normal. He was
prescribed with chondroino sodium sulfate used as antirheumatic, B-complex used as
vitamin supplement, Pergabalin used as anticonvulsant, Ciprofloxacin used as
antibiotics, Paracetamol used as analgesic . The patient was counselled accordingly
with aspect to disease, drug, and life style modification to control the problem and to
improve the quality of life.

9. GUIDELINES:
 NSAIDS should be prescribed for osteoarthritis but the prescriber didn’t
prescribe .

10. Patient counselling
Regarding diseases:
Osteoarthritis (OA) is a type of joint disease that results from breakdown of
joint cartilage and underlying bone. The most common symptoms are joint pain and
stiffness . Causes include previous joint injury, abnormal joint or limb development,
and inherited factors. Degeneration of joint cartilage and the underlying bone, most
common from middle age onward. It causes pain and stiffness, especially in the hip,
knee, and thumb joints. If not treated complication such as bone death
(osteonecrosis) stress fractures. bleeding or infection in your joint. deterioration of
tendons and ligaments around joints. pinched nerve, in OA of the spine, cancer.

11. Regarding medication:
The patient was treated with T.TENDOCARE (chondroino sodium sulfate) mixed dose orally.
Twice daily.
The common side effects head ache, nausea , vomiting, diarrhea, fever, bloating .
In case of bloating, chew some fennel seeds, ginger can also helps in reducing bloating.
In case of headache, eat well, take deep breath and sleep well.
In case of diarrhea, avoid spicy foods, fruits, alcohol and caffeine, honey consumption
can cure diarrhea.
In case of nausea and vomiting, drinking water or broths are advisable. Stay away from
fried or greasy foods.
Take mixed dose as soon as possible within 1-2 hours if the frequency is once or twice
daily. but do not double dose .

12. REGARDING MEDICATION:
 Tab. B.complex an vitamin supplements is advised to administered orally twice a
day half and hour after meals. The common side effects diarrhea, skin rashes,
dizziness, nausea, itching, vomiting .
In case of dizziness, deep breathing is one of the best ways o deal with dizziness,
which provides adequate amount of oxygen to the brain and relax the nervous
system.
In case of nausea and vomiting, drinking water or broths are advisable. Stay away
from fried or greasy foods.
In case of rashes cleansing property of oat meal will help to reduce acne scars,
blend oat meal with water.
 The patient was treated with Inj.ciprofloxacin (20mg) twice a day
intramusucularly. The side effects are stomach pain, dizziness, diarrhea, headache

13. REGARDING MEDICATION:
 Tab . Pregabalin(75mg) an anticonvulsant is advised to administer orally twice a day . The
common side effects vomiting, muscle cramps, fatigue, sore throat, blurred vision
In case of fatigue, eating bananas, green tea and pumpkin seeds can fight against fatigue.
In case muscle cramps prevented by measures such as adequate nutrition and hydration
attention to safety when exercising and attention to ergonomic factors and also by stretching
your muscle.
In case of blurred vision eye exercise can be done which makes eye muscles more
flexible and brings energy and blood flow to the eyes to maintain optimal vision.
The patient was treated with Tab.Paracetamol (500mg) orally twice a day after food. The
side effects are loss of appetite, nausea, vomiting, stomach pain, and confusion.

14. REGARDING LIFESTYLE MODIFICATION:
Do not take a double dose to make up for a for a forgotten dose.
 If you forget to take it , as soon as you remember and then continue to take next
dose at right time.
 Exercise is a long term treatment for rheumatoid arthritis.
 Taking low calorie food is used to maintain healthy.
Try to keep your body weight at a healthy level to avoid putting additional stress
on joints.
 Try to exercise your joints and muscles as much as possible without doing harm.
 Joints need to be kept moving so they do not seize up.

15. REGARDING LIFESTYLE MODIFICATION:
Avoid violent exercise and contact sports. Walking and swimming
are good form of exercise.
 Calcium tablets are used to strengthen the bones.
 If overweight, reduce the weight.
 Regular medicine intake
 Improve the quality of life.

16. REGARDING LIFESTYLE MODIFICATION:
The patient is advised to take plenty of water which increases blood volume.
The patient must avoid dehydrating drinks like alcohol and coffee and triggers
such as a high temperature environment must be avoided.
Patient should sit up and breathe deeply as they get up of bed in the morning.
Patient was advised do not stop or change the dose of the medicine without
consultation of doctor.
Consult doctor even before using an OTC medication.
Emphasize importance of following examination to monitor progress of therapy.

17. THANK
YOU!