1. A patient presents to your pharmacy complaining of knee pain and would like recommendations on what products he should use to help relieve his symptoms. You ask him to describe his knee pain and he states that he notices the discomfort first thing in the morning, but it lasts most of the day and is not relieved with rest. He also reports that he hears a “popping” sound with knee flexion and that his knee has been swollen for at least 2 days. Which of these symptoms is not consistent with osteoarthritis of the knee?

2. What benefit(s) may pharmacists provide for patients with knee osteoarthritis?

3. The presence of which of the following conditions would classify a patient as having a high comorbidity risk according to the Osteoarthritis Research Society International guidelines?

4. Platelet-rich protein (PRP) is a form of therapy for the treatment of knee osteoarthritis (OA). Which of the following benefits does it provide for patients?

5. What evidence-based resources are available for helping patients achieve weight loss?

6. Which pharmacologic therapy option for the management of pain in osteoarthritis (OA) is supported by all knee OA guidelines?

7. CASE STUDY: Use the following case to answer questions 7 through 10.
MM is a 58-year-old man with hypertension, dyslipidemia, and diabetes. His current medications are metformin XR 1000 mg twice daily, lisinopril 40 mg once daily, and atorvastatin 10 mg once daily. He is purchasing a bottle of ibuprofen for his knee pain. You share your concern with the use of a nonsteroidal anti-inflammatory drug in the setting of his comorbidities and he explains that he has struggled to maintain attendance in his water aerobics class because his knee pain is not sufficiently managed with daily acetaminophen therapy. The aerobics instructor recommended he try ibuprofen since acetaminophen was not sufficiently managing his pain and supporting his daily functional goals. He explains that he is suffering from knee pain daily, despite his knee exercises and daily intake of acetaminophen at maximum doses.

Which of the following options would be the safest and most appropriate recommendation for MM at this time?

8. CASE STUDY: Use the following case to answer questions 7 through 10.
MM is a 58-year-old man with hypertension, dyslipidemia, and diabetes. His current medications are metformin XR 1000 mg twice daily, lisinopril 40 mg once daily, and atorvastatin 10 mg once daily. He is purchasing a bottle of ibuprofen for his knee pain. You share your concern with the use of a nonsteroidal anti-inflammatory drug in the setting of his comorbidities and he explains that he has struggled to maintain attendance in his water aerobics class because his knee pain is not sufficiently managed with daily acetaminophen therapy. The aerobics instructor recommended he try ibuprofen since acetaminophen was not sufficiently managing his pain and supporting his daily functional goals. He explains that he is suffering from knee pain daily, despite his knee exercises and daily intake of acetaminophen at maximum doses.

MM returns to your pharmacy 1 year later, frustrated with his ongoing knee pain. He explains that the intra-articular corticosteroids only provide pain relief for approximately 1 month and then he becomes more and more uncomfortable with his daily activities. In addition to the intra-articular corticosteroid injections he receives every 4 months, he takes acetaminophen 1000 mg as needed for pain: he explains that, beginning approximately 1 month after receiving each injection, he takes acetaminophen several times daily. He is also taking chondroitin/glucosamine daily and he applies capsaicin cream every evening. Which of the following modifications can he make to his daily medication regimen that might help to improve his symptoms?

9. CASE STUDY: Use the following case to answer questions 7 through 10.
MM is a 58-year-old man with hypertension, dyslipidemia, and diabetes. His current medications are metformin XR 1000 mg twice daily, lisinopril 40 mg once daily, and atorvastatin 10 mg once daily. He is purchasing a bottle of ibuprofen for his knee pain. You share your concern with the use of a nonsteroidal anti-inflammatory drug in the setting of his comorbidities and he explains that he has struggled to maintain attendance in his water aerobics class because his knee pain is not sufficiently managed with daily acetaminophen therapy. The aerobics instructor recommended he try ibuprofen since acetaminophen was not sufficiently managing his pain and supporting his daily functional goals. He explains that he is suffering from knee pain daily, despite his knee exercises and daily intake of acetaminophen at maximum doses.

MM returns for advice on the next steps he should take in the management of his knee osteoarthritis (OA). He is receiving intra-articular corticosteroid injections every 4 to 6 months, he uses acetaminophen for breakthrough pain, and he is applying capsaicin as instructed. He does water aerobics 3 to 4 times a week and walks his dog daily. What treatment option is missing from his therapy that is considered a first-line option in the management of knee OA?

10. CASE STUDY: Use the following case to answer questions 7 through 10.
MM is a 58-year-old man with hypertension, dyslipidemia, and diabetes. His current medications are metformin XR 1000 mg twice daily, lisinopril 40 mg once daily, and atorvastatin 10 mg once daily. He is purchasing a bottle of ibuprofen for his knee pain. You share your concern with the use of a nonsteroidal anti-inflammatory drug in the setting of his comorbidities and he explains that he has struggled to maintain attendance in his water aerobics class because his knee pain is not sufficiently managed with daily acetaminophen therapy. The aerobics instructor recommended he try ibuprofen since acetaminophen was not sufficiently managing his pain and supporting his daily functional goals. He explains that he is suffering from knee pain daily, despite his knee exercises and daily intake of acetaminophen at maximum doses.

MM is concerned because his prescriber recommended that he discontinue the intra-articular corticosteroids. He explains that his prescriber cautioned him that the intra-articular corticosteroids were likely speeding up the cartilage degradation in his knees. MM wants to know if there are other injections from which he may obtain benefit that will not exacerbate his cartilage volume loss. On the basis of the information provided, which of the following options are most appropriate for MM?

Evaluation Questions

11. How confident are you in your decision about your treatment suggestions for MM in the case above?

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