Case presentation on osteoarthitis

SOAP notes

1. Case presentation on Osteoarthritis Presented by R.Anusha Pharm D 5 th year Roll no : 07 1

2. Patient name: Mrs. J Gender: Female Age: 56 years IP no: 282115 DOA:18/9/2018 DOD: 21/9/2018 2

3. Chief Complaints : Complaints of pain in right hip and both knees Past Illness History: Past history of revision THR right side . Knee pains-gradually progressive. No H/o Trauma. Past Medical History : K/c/o HTN – On medication. Past Medication History: T . NEFIDIPINE 30mg PO OD T.AMILORID(Amiloride 5mg+Hydrochlorthiazide 50mg) OD ALLERGY: Allergy to blood transfusion. SUBJECTIVE 3

4. OBJECTIVE Vitals: Temperature: Normal Pulse rate:86/min Respiratory rate:20/min Blood pressure:130/80 mm of Hg 4 Physical appearance: Height:158cms Weight:88.6kgs BMI:35Kg/m 2

5. Lab investigations: CBP:WNL CUE:WNL ECG:WNL ESR:28(0-28mm/hr) CRP:3.59(< 3 mg/L) FINAL DIAGNOSIS: Osteoarthritis both knees 5

6. Procedure: BMAC injection was given to both knees. Drug chart BRAND GENERIC DOSE FREQ. ROA CATEGORY INDICATION T.NEFIDIPINE Nefidipine 30mg OD PO CCB HTN T.AMILORID Amiloride Hydrochlor thiazide 5mg, 50mg OD PO K+ Sparing agent, Thiazide diuretic HTN 6

7. GOALS OF THE THERAPY To educate the patient and family members. To relieve pain and stiffness To maintain or improve joint mobility To limit functional impairment and to maintain or improve quality of life To maintain a blood pressure of below 140/80 mm Hg (K/C/O HTN) 7

8. ASSESMENT A 54YOF, Mrs. J came with complaint of pain in right hip and both knees. Knee pain gradually progressive. On evaluation patient was diagnosed with K/C/O OSTHEO ARTHRITIS both knees. Patient has past H/o right revision TOTAL HIP REPLACEMENT (long stem with trochanteric wiring) 4 times , which is usually done when all other treatment options have failed to provide adequate pain relief. Bone scan of right hip done-Scan negative for loosening or infective pathology involving the right hip prothesis. So, now p atient may need injection BONE MARROW ASPIRATE CONCENTRATE to both knees which is natural alternative to surgical intervention. 8

9. Bone Marrow Concentrate(BMC) Therapy, also known as Bone Marrow Aspirate Concentrate(BMAC) Therapy, is a promising non surgical regenerative therapy to accelerate healing in severe osteoarthritis. The bone marrow contains a reservoir of “pluripotent” stem cells that can be withdrawn from the patient’s hip bone and used for the procedure. With BMC, the concentrate of regenerative cells provides a more robust healing of the damaged tissue and aids in growth and repair by accelerating the body’s natural healing mechanism. BMAC was done to both knees and post BMAC was uneventful. Patient was a known case of hypertension and T.AMILORID(Amiloride 5mg+Hydrochlorthiazide 50mg) OD was continued in hospital. A thiazide is the preferred type of diuretic for hypertension and is considered a first-line therapy option in most patients with hypertension. 9

10. Hydrochlorothiazide is a “thiazide-type” agent; usual dose is 12.5-50 mg/day. Potassium sparing agents (Amiloride) are used only in conjunction with a thiazide diuretic to prevent K+ loss and to augment the antihypertensive action. T. NEFIDIPINE 30mg PO OD was continued in hospital. A long-acting dihydropyridine CCB should be strongly considered as preferred add-on therapy when a thiazide is not controlling BP in a patient and no other compelling indications. Nifedipine usual dose is 30-90 mg /day OD. It reduces CV morbidity and mortality as add on therapy with thiazide diuretic. Patient was discharged in heamo -dynamically stable condition. 10

11. PLAN Monitoring parameters: Disease related Post-injection soreness at the injection site is some times present because of an inflammatory response caused by BMC therapy. Monitor Blood pressure. Drug related BIDURET(Amiloride + Hydrochlorothiazide):Monitor Potassium levels. RECOMMENDATIONS: Pain killers like Tramadol should be given to control the pain. DVT prophylaxis is must because patient is obese in this case. 11

12. Patient counselling: DISEASE RELATED: For the first 2-7 days, swelling and discomfort are typical in the injected area. By the end of the first week, these symptoms usually begin to resolve. Most patients notice some level of improvement by 2-6 weeks following BMC. Increased stability and strength are typically reported along with the decrease in pain. A second level of benefits may be obtained between 6 weeks and 3 months. It is important that anti inflammatory medications such as Ibuprofen, Naproxen and Aspirin should be avoided following treatment because these medicines may block the effects of the intended healing response facilitated by the post injection inflammation. 12

13. DRUG RELATED OSTEOARTH 2g (Nutritional supplement-Chondroitin sulfate,Collagen peptide,Curcumin,Ginger extract,Glucosamine,Piperine,Vitamin C ) to be taken twice daily orally after food for 6 months.(given for osteoarthritis) BIDURET 50mg (Amiloride 5mg + Hydrocholorothiazide 50mg) 1 tab to be taken once daily orally after food.(continue it for hypertension). NICARDIA RETARD 20mg (Nifedipine 20mg) 1 tab to be taken once daily orally after food.(continue it for hypertension). NICARDIA RETARD 10mg (Nifedipine 10mg) 1 tab to be taken orally once daily orally after food.(continue it for hypertension). 13

14. Life style modifications Maintain normal body weight - body mass index 18.5-24.9 kg/m 2 Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat. 14