Knee Pain and Stiffness

🗒️ Question

A 68 year old woman presents to her GP with chronic pain and stiffness in both knees. The pain is worse after activity and alleviated by rest. She reports no morning stiffness lasting longer than 30 minutes and denies systemic symptoms such as fever or weight loss. Her past medical history includes hypertension which remains controlled on ramipril. She has been taking over the counter ibuprofen occasionally with partial relief.

On examination, her knees are swollen with palpable osteophytes but there is no warmth or erythema. Crepitus is noted on movement and her range of motion is reduced bilaterally.

What is the most appropriate initial management?

(A) Oral diclofenac

(B) Referral for arthroscopic surgery

(C) Topical NSAIDs

(D) Weight loss and exercise

(E) Corticosteroid injection