Ihuman Case on Chronic Progressive Knee Pain in an 83-Year-Old Female; A Clinical Case of Bilateral Osteoarthritis -Week#9

Ihuman Case on Chronic Progressive Knee Pain in an 83-Year-Old Female; A Clinical Case of Bilateral Osteoarthritis -Week#9

Note: This case focuses on an 83-year-old obese female presenting with chronic bilateral knee pain, more pronounced in the right knee, consistent with osteoarthritis. The patient describes a five-year history of progressive pain, stiffness, and functional limitation that interferes with daily activities such as walking and climbing stairs. Morning stiffness lasting less than 30 minutes and pain localized to the medial aspect of the knee joints are hallmark features of OA.

Patient Initials: M.J.

Patient DOB or age: 83 years old

Date of Encounter: october 20, 2025

Subjective:

Chief Complaint: An 83-year-old female with a past medical history significant for hypertension on HCTZ and Lisinopril, obesity, and peptic ulcer due to ibuprofen use who presents with a chief

complaint of “I’m having pain in my knees, and I am ready to do something about it. That is why

I came in”.

HOPI: An 83-year-old obese female who presents for an initial visit for chronic progressive knee pain, with the right knee being worse than the left. SHE is an existing patient and a reliable historian. She reports morning stiffness in her knees and fingers lasting under 30 minutes. The knee pain began about five years ago and has progressively worsened. The pain started gradually without

any triggering fall or trauma. It is located primarily on the knees' inner (medial) sides. Initially, the pain was intermittent but has become constant. Mabel describes the pain as "stiff and achy," exacerbated by cold weather, mornings, climbing stairs, and walking. She has been taking acetaminophen with minimal relief. The pain is worse in the

morning and during winter, usually rated 4 to 5/10 but sometimes reaching 7 to 8/10. The knee pain significantly affects her daily life, making movement uncomfortable and causing frustration. Despite the pain, she manages her daily activities with more time and discomfort. Mabel can access healthcare through her insurance. She has easy access to appointments and visits to the pharmacy. Due to the discomfort and altered gait, she has started using a cane.

Past Medical History:

• Chronic Joint Pain: onset is five years ago, uncontrolled with

extra strength acetaminophen

• Hypertension: date of onset is 20 years ago, controlled

• Peptic Ulcer disease with GI bleeding from ibuprofen: onset almost

two years ago, controlled with pantoprazole (GIB since healed)

• OB/GYN history: G6P6 (#1-5 vaginal deliveries; #6 C-section,

uncomplicated)

Past Surgical History:

• C-Section with 6th child (date unknown) uncomplicated

• Two hyperplastic polyps were removed during a colonoscopy four

years ago, and no complications.

Hospitalizations:

She was hospitalized for the birth of her children with no complications.

Medications:

• Lisinopril 10 mg tablet by mouth once daily for hypertension

Hydrochlorothiazid

e 25 mg tablet by mouth once daily for hypertension

• Pantoprazole 40 mg tablet by mouth once daily for Peptic Ulcer.

• Acetaminophen OTC 500 mg (2 tablets) by mouth three times daily for

knee pain PRN.

• Multivitamin one tablet PO daily

Allergies: No known medication, food, or environmental allergies.

Vaccines: Vaccines up to date. Up to date on COVID and flu. Received pneumococcal at age 65. Tdap at age 75.

Health promotion/preventative care:

• Pap testing in the past was all negative. The last one > was 5 years ago.

Mammogram deferred.

• A colonoscopy was done four years ago, and two hyperplastic polyps were

removed.

• A DEXA scan is normal for age and was performed this year.

Family Hx:

• Father- deceased from MI, had uncontrolled hypertension (age at death

68)

• Mother- deceased from natural causes (had moderate arthritis and

well-controlled hypothyroidism, “lazy thyroid.” (age at death 76)

• Sister- alive (80), Hypertension and diabetes well controlled on medication

• Grandparents: Information not provided/unknown

• Children: All alive and healthy

Social Hx:

• Tobacco: Never smoke

• Alcohol/drugs: Denies drinking alcohol and drug use

• Diet: Eats three meals daily, Diet high in purines, likes sweets,

drinks 64 ounces water/fluids daily

• Activity: Minimal; putters around her garden; activities limited due to

joint pain and stiffness. Lives alone on the first floor. Enjoy family

time with her grandchildren.

• Sleep: gets 6-8 hours of sleep every night

• Marital Status: Widowed

• IPV: Denies

• Spirituality: Goes to church every Sunday, and Wednesday nights for

potluck supper

ROS:

General: Negative for substantial weight gain, fatigue, fevers, or headache.

Skin: Negative for erythema or warmth to the affected areas.

HEENT:

Cardio: Negative for any chest pain or palpitations. Respiratory: Negative for

shortness of breath or cough. Abdomen:

Genitourinary/Reproductive: