Reference no: EM133867371

Problem

A 78-year-old patient comes to the office for evaluation of increasing right knee pain. She has been treated for osteoarthritis for several years and she had been doing well until well last weekend when she developed increased pain after taking her usual short walk with her 4-year-old granddaughter. She did not fall or recall an injury to her knee but reports that her right knee has become swollen and it is now painful to walk. She received an "injection" in her right knee eight months ago, and a second injection four months ago, when she had similar symptoms. She is requesting another injection so that she can get back to her usual level of function as soon as possible. Her past medical history includes hypertension, diabetes, and gastrointestinal bleed. She takes hydrochlorothiazide 25 mg/day, benazepril 20 mg/day, metformin 500 mg three times daily, acetaminophen 4.0 grams daily, and hydrocodone 5 mg three times daily. Lab results include uric acid 6 mg/dL [Normal: 2.3-6.6 mg/dL] and rheumatoid factor negative. Get the instant assignment help. Physical exam shows her temperature is 37 C (98.6 F) [Normal: 37 C (98.6 F)], pulse is 66 beats/minute [71-121 beats/minute], blood pressure is 128/74 mmHg [Normal: 139/68 mmHg], weight is 84 kg (185 lbs), height is 178 cm (70 in), and body mass index is 26.5 kg/m [Normal: 18.5-24.9 kg/m2]. Her right knee demonstrates fluctuate medially, is cool to the touch, and tender with pressure and extension. The remainder of the examination is within normal limits. Which is the most appropriate response to this patient's request for a joint injection?