April 1, 2009

Joint pain in elderly

A 60 years old obese female presented to your clinic after cannot bear the pain of the knee joint. The pain has been present since 2 years ago, gradually increase in intensity and associated with morning stiffness. Bilateral lower limb X ray was taken.

1) What other history you would like to obtain?

2) Name three differential diagnosis

3) Name two abnormalities in picture A

4) What other clinical signs you would like to elicit?

5) Outline the radiological finding in picture B

6) Name two management for this patient



- Is it aggravated by movement (OA worsen with movement, RA relieve by movement)

- Any family history of rheumatoid arthritis?

- Occupational involving handling heavy object?

- Any pain on climbing stairs (rule out involvement of patellofemoral joint)

- Any history of infection with TB (rule out tuberculous arthritis)


- Osteoarthritis (most common in elder female+obese)

- Rheumatoid arthritis

- Septic arthritis


- Bilateral knee joint swelling

- Genu valrus


- Joint crepitus

- Limited range of movement on knee.

- Osteophytes formation (Irregular and protuberant feeling at edge of articular ligament)

- Antalgic gait


- Decreased joint space at weight beiring site

- Osteophytes formation

- Subchondral cyst (not seen in this x ray)

- Subchondral sclerosis

- Loose bodies (calcified cartilage, free lying bone in joint space; also not seen in this x ray)

6) Depend whether mild, moderate or severe

- Analgesic (NSAIDS, opiods, opiods+paracetamol)

- Load reduction (weight loss, cane)

- Glucosamine

- Arthroscopic debridement

- Arthroplasty

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