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Analgesia in CKD — RACP Adult Medicine MCQ

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HardClinical PharmacologyAnalgesia in CKDRACP Adult Medicine

A 70-year-old with symptomatic knee osteoarthritis has eGFR 38 mL/min/1.73 m², previous peptic-ulcer bleeding and low-dose aspirin use. Paracetamol and topical NSAID have been inadequate. Which next strategy offers symptom relief without defaulting to a hazardous chronic oral analgesic?

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Reveal the answer and explanation

Correct answer: B — Offer an intra-articular corticosteroid for short-term relief alongside exercise, weight and biomechanical management

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · B = shown as D · A = shown as E

C is correct. Intra-articular corticosteroid can provide short-term relief while the durable programme remains exercise, weight management where relevant, aids and consideration of definitive joint intervention. This avoids chronic systemic exposure in a patient with combined kidney, gastrointestinal and cardiovascular risk. D retains renal and cardiovascular toxicity despite gastric protection. E does not abolish kidney or cardiovascular harm and still interacts with the overall antiplatelet-risk context. A is not disease-modifying and creates systemic toxicity. B makes a dependence-, fall- and delirium-prone opioid the indefinite default and requires renal caution. The injection is episodic, not a substitute for rehabilitation or timely arthroplasty assessment.

Reference: RACGP: Guideline for the management of knee and hip osteoarthritis: https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/knee-and-hip-osteoarthritis