A 76-year-old woman with osteoarthritis of both knees has tried Paracetamol QDS, topical NSAIDs, and intra-articular corticosteroid injections without...

Question

A 76-year-old woman with osteoarthritis of both knees has tried Paracetamol QDS, topical NSAIDs, and intra-articular corticosteroid injections without adequate pain relief. She has CKD stage 3b (eGFR 34). She asks about other options. What is the MOST appropriate next step according to NICE?

Accepted Answer

Consider referral for surgical assessment for total knee replacement, alongside continued non-pharmacological management (exercise, weight management, physiotherapy)

Answer

Prescribe oral Naproxen 500 mg BD

Answer

Prescribe Codeine 30 mg QDS as next-step analgesia

Answer

Prescribe Gabapentin 300 mg TDS for nociceptive joint pain

Answer

Prescribe Celecoxib as it is safer than Naproxen in CKD

uk-dgm MCQ (SBA): Refractory OA in CKD - Surgical Referral

A 76-year-old woman with osteoarthritis of both knees has tried Paracetamol QDS, topical NSAIDs, and intra-articular corticosteroid injections without adequate pain relief. She has CKD stage 3b (eGFR 34). She asks about other options. What is the MOST appropriate next step according to NICE?