Question 8#

A 60-year-old man complains of pain in both knees coming on gradually over the past 2 years. The pain is relieved by rest and worsened by movement. The patient is 5 ft 9 in tall and weighs 210 lb. There is bony enlargement of the knees with mild warmth and small effusions. Crepitation is noted on motion of the knee joint bilaterally. There are no other findings except for bony enlargement at the distal interphalangeal joint. Which of the following is the best way to prevent disease progression?

A) Weight reduction
B) Calcium supplementation
C) Total knee replacement
D) Long-term nonsteroidal anti-inflammatory drug (NSAID) administration
E) Oral prednisone

Correct Answer is A


The clinical picture of pain in weight-bearing joints made worse by activity is suggestive of degenerative joint disease, also called osteoarthritis. Osteoarthritis may have a mild to moderate inflammatory component. Crepitation in the involved joints is characteristic, as is bony enlargement of the DIP joints. In this overweight patient, weight reduction is the best method to decrease the risk of further degenerative changes. Aspirin, other NSAIDs, or acetaminophen can be used as symptomatic treatment, but these agents do not affect the course of the disease. The long-term use of NSAIDs is limited by potential side effects, including renal insufficiency and gastrointestinal bleeding. Calcium supplementation is relevant for osteoporosis, but does not treat osteoarthritis. Oral prednisone would not be indicated. Intra-articular corticosteroid injections may be given two to three times per year for symptom reduction. Knee replacement is the treatment of last resort, usually when symptoms are not controlled by medical regimens and/or activities are severely limited.