Knee osteoarthritis — SCE Rheumatology MCQ

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EasyOsteoarthritis and Soft Tissue RheumatologyKnee osteoarthritisSCE Rheumatology

A 72-year-old man with symptomatic knee osteoarthritis asks for analgesia to help him walk. He has CKD stage 3b and previous peptic ulcer bleeding. The knee is not hot and there are no systemic symptoms. He has already started strengthening exercises. What is the most appropriate management?

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Correct answer: A — Offer topical NSAID

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

Offer topical NSAID is best because topical NSAIDs are recommended for knee OA and have lower systemic risk than oral NSAIDs. A is less suitable because high-dose oral ibuprofen is risky with CKD and previous GI bleeding; B is less suitable because allopurinol lowers urate and does not treat OA pain; D is less suitable because methotrexate treats inflammatory arthritis rather than OA; E is less suitable because colchicine treats crystal flares. Clinical pearl: topical treatments are often the safest pharmacological step in older patients with OA.

Reference: NICE NG226; BNF