A 74-year-old female presents to the clinic with complaints of increased difficu

A 74-year-old female presents to the clinic with complaints of increased difficulty in getting up from a seated position and worsening right knee pain over the last few months. The patient reports the pain is a 6/10 and is not relieved with Tylenol. The pain is sharp at times to her knees but aches at night when she is trying to rest. The patient denies any recent injuries to her knee. The patient has a history of diabetes type 2 and hypertension. The patient is taking metformin 500mg PO twice daily and lisinopril 10mg po daily. Patient is 5’8” and weighs 220 pounds. BP is 122/84, pulse is 72, resp 18, regular and non labored, pulse ox 96%, and temp 98.8F. Physical exam reduced ROM to right knee and complaints of pain with flexion; bilateral knee crepitus worse in the right knee. No erythema to knee joints but mild edema noted bilaterally. The patient reports tenderness to both knees upon palpation. Diagnostic testing ESR 14 mm/hr. CMP otherwise normal except for non fasting glucose of 220 mg/dL. Right and left knee xray: Moderate degenerative changes with joint space narrowing, no radiographic evidence of osteoporosis or joint effusion. Based on this result and exam findings the patient is given a diagnosis of osteoarthritis.