GP CCE Cases · musculoskeletal-presentations
Knee osteoarthritis uncontrolled on pills — CCE clinical encounter
CCE-style clinical encounter: a 63-year-old cleaner with painful knee osteoarthritis, a self-started paracetamol habit, and fear that her knee is 'worn out'. The candidate must diagnose clinically without imaging, restructure care around exercise and weight loss with quantified benefit, and prescribe topically.
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Prompt
A 63-year-old hospital cleaner attends with nine months of right knee pain worse on stairs and at end of shift. Morning stiffness lasts about 15 minutes. She takes four paracetamol tablets most days with little effect. BMI 32. Examination: bony swelling, crepitus, small effusion, no instability, full extension. No trauma, no night pain, no systemic features.
Objectives
- Diagnose osteoarthritis clinically using the three criteria, and explain why imaging is not needed. [2]
- Reframe management around exercise (≈12 points pain reduction) and weight loss (10% beats 5%) as genuine treatment. [1][4]
- Stop routine paracetamol with the trial evidence, and start topical NSAID first-line. [3][2]
- Address the "worn out" belief and set realistic expectations including flares. [1]
- Safety-net for atypical features and plan follow-up. [2]
References4ShowHide
- [1]Fransen M et al. Exercise for osteoarthritis of the knee. The Cochrane database of systematic reviews, 2015.PMID 25569281
- [2]Derry S et al. Topical NSAIDs for chronic musculoskeletal pain in adults. The Cochrane database of systematic reviews, 2016.PMID 27103611
- [3]Leopoldino AO et al. Paracetamol versus placebo for knee and hip osteoarthritis. Annals of the rheumatic diseases, 2019.PMID 30801133
- [4]Messier SP et al. Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better? Arthritis care & research, 2018.PMID 29911741