More commonly known as gout, monosodium urate crystal deposition (MSU) induced arthritis is a disorder characterized by the deposition of MSU crystals in joints and subcutaneous tissue. The metabolic disorder underlying gout is hyperuricemia.

Knee pain is a common condition seen by healthcare professionals. Patients with knee problems accounted for approximately 19 million visits to physician offices in 2003 and approximately 25 percent of older Americans report suffering from chronic knee pain.1,2 Many of these patients seek medical attention after recurrent pains have gone unaddressed or after suffering an insidious, gradual decline in their functional mobility.

Q: An 80-year-old patient with severe osteoarthritis of the knees has hypertension and chronic renal failure severe enough to preclude the use of NSAIDs or surgery. How can I treat this patient?

A 62-year-old woman presents with a fever, right knee pain and swelling for 24 hours. The patient says she was gardening two weeks ago and bumped her right knee on the cement. At that time, she experienced slight discomfort in the knee but was able to continue to garden. The patient states the right knee pain is not like her “typical” pain from rheumatoid arthritis (RA). She describes a sudden onset of non-radiating pain associated with fever and chills. She is unable to bear weight due to the right knee pain.

An 18-year old male cross-country runner presents with a swollen right knee. He says the swelling has been intermittent for the past month and has affected both knees. The patient has been treating the swelling with ice and ibuprofen. The patient is currently “between seasons” as he runs cross-country in the fall and track in the spring. He does not recall any related injuries from his competitive running.

Bridgette, a 26-year old white female presents with a six-month history of right knee pain. Although she cannot attribute the onset of her pain to a particular activity, she thinks it may have started after beginning to train for an upcoming marathon.

While the pain had previously been intermittent, Bridgette states it has become progressively more frequent and intense. The pain is somewhat diffuse but commonly occurs along the medial side of the knee, particularly along the medial edge
of the patella.

A 19-year-old Caucasian male presents to the clinic and has had lower right knee pain for the last three weeks. He plays soccer and has a long history of bilateral knee injury. However, he recently missed soccer practice due to pain that occurs with walking. He says the pain has become much worse in the past week despite the use of icing and non-steroidal antiinflammatory drugs (NSAIDs). The pain does not change character with motion and becomes worse at night.

Yes. Amy Pickens, MPAS, PA-C, says the over-the-counter supplement is a safe treatment option within the armamentarium of modalities for osteoarthritis of the knee. No, Blaine Carmichael, PA-C, says the literature and the general makeup of a glucosamine/chondroitin supplement makes it a less than viable treatment option for osteoarthritis of the knee.

Yes. This author says the over-the-counter supplement is a safe treatment option within the armamentarium of modalities for osteoarthritis of the knee.

By Amy Pickens, MPAS, PA-C

Many of my colleagues have voiced concerns regarding the use of nutriceuticals in their practices. The expressed concerns range from “These things are unproven” and “there is no FDA scrutiny over these products” to “they don’t work all the time” and “there are no scientific, double-blind, placebo-controlled studies on their safety or effectiveness.”

Statistics from the National Center for Chronic Disease Prevention and Health Promotion reveal that nearly 70 million Americans are affected by arthritis and chronic joint pain.1 There are 315 million office visits per year for musculoskeletal complaints and 10 percent of all outpatient visits in general medicine are related to joint pain.2,3

With these statistics in mind, let us consider the following case vignette that involved an elderly patient with knee pain.