1. 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 500mg

2. LABORATORY INVESTIGATIONS :
PERSONAL HISTORY :
Menopause – 3 years back
LABORATORY INVESTIGATIONS :
GRBS at the time of admission is 239 mg/dL
CBC
TEST VALUE
NORMAL RANGE
WBC
16,500 cumm
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
ESR
90 mm/hr
< 20 mm/hr

3. 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/dL which suggests diabetes mellitus.

4. 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.

5. 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.
NSAIDS :- Diclofenac inhibits PG synthesis where PG’s are mediators of pain
325mg TID
mg/day

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

7. DISCHARGE DRUGS :
T. Reboron
T. Melmet SR 500mg
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