OSTEOARTHRITIS SCENARIO Here is a 55 yrs old

OSTEOARTHRITIS • SCENARIO: Here is a 55 yrs old female patient hospitalized for 10 days. • CHIEF COMPLAINTS : Pain in left knee since 15 days. Swelling B/L lower limb since 8 days. • HISTORY OF PRESENT ILLNESS : Patient complains of pain in left knee which is gradually progressive, throbbing type aggravates on moving and relieves on taking rest. • PAST MEDICAL HISTORY : k/c/o Type 2 DM since 1 month. • PAST MEDICATION HISTORY : Tab Metformin 500 mg 1 -0 -1

• PERSONAL HISTORY : Menopause – 3 years back • LABORATORY INVESTIGATIONS : CBC TEST VALUE NORMAL RANGE WBC 16, 500 cumm 4000 -11000 cumm Haemoglobin 9. 5 g/dl 11 -14 g/dl Neutrophils 82 40 -60 MCH 24. 8 g/dl 32 -36 g/dl MCHC 28. 3 g/dl 32 -36 g/dl ESR 90 mm/hr < 20 mm/hr • GRBS at the time of admission is 239 mg/d. L

• SOAP Note : • Subjective : Here is a 55 years old female patient complaining of pain in left knee and swelling of lower limb. • Objective : WBC is increased to 16, 500 cumm which is due to infection or inflammation. Hb decreased to 9. 5 g/dl which implies anaemia MCH is decreased to 24. 8 g/dl which indicates hypochromia MCHC is decreased to 28. 8 g/dl which also indicates hypochromia ESR is increased to 90 mm/hr which is due to inflammation. GRBS increased to 239 mg/d. L which suggests diabetes mellitus.

• Antibiotic sensitivity testing : - (pus samples) Organism – Methicillin resistant Staphylococcus aureus. Sensitive to Erythromycin, Tetracycline, Cloxacillin, Amoxiclav, ceferoxime. • Diagnosis : Osteoarthritis • Assessment : • Pain in knee : Due to osteoclast activity release of vasoactive peptide and matrix metalloproteinase, neovascularisation increased permeability of the adjacent cartilage, which leads to cartilage degradation and eventually cartilage loss resulting in pain. • Swelling : Due to release of inflammatory mediators synovitis occurs which causes swelling. • Osteoarthritis : Due to progressive deterioration and loss of articular cartilage.

PROBLEM GOALS OF TREATMENT DRUGS & MOA DOSAGE Osteoarthritis Relieve pain and stiffness Improve joint mobility Limit functional impairment Acetaminophen : they inhibit PG synthesis which causes algesia. 325 mg TID NSAIDS : - Diclofenac inhibits PG synthesis where PG’s are mediators of pain 100150 mg/day

• Plan : TRADE NAME GENERIC NAME DOSAGE 1 2 3 4 5 6 7 8 Inj. Contra mol Tramadol 100 ml 1 -0 -1 Y Y Y Y T. Neusaid Aceclofenac+ paracetamol 1 -0 -1 Y Y Y Y T. Rabsure Rabeprazole 40 mg Y Y Y T. Phlogam Trypsin , brome lain, rutoside trihydrate 1 -1 -1 Y Y T. Neuromi ne Merobalamine 0 -1 -0 Y Y Y T. Zifi turbo Linezolide 1 -0 -1 T. Melmet Metformine 500 mg Syp. Heam up Ferrous sulphate 5 ml 9 10 Y Y Y Y Y Y Y Y

• DISCHARGE DRUGS : T. Reboron T. Melmet SR 500 mg • DRUG INTERACTIONS : Tramadol + linezolide – Major interaction Nausea , sweating , increased heart rate , serotonin syndrome • PATIENT COUNSELLING: While using Metformin might feel a little irritation in GIT Weight control Reduce protein in diet Rabeprazole should be taken before food