26th January 2024

A 72-year-old female presents with increasing pain in the right knee, on a background of known osteoarthritis.

A 72-year-old female presents with increasing pain in the right knee, on a background of known osteoarthritis. She had been using regular paracetamol and topical ibuprofen gel, but recently, this has not helped and is causing significant difficulty in walking and carrying out her daily tasks. Her past medical history includes hypothyroidism, type 1 diabetes, hypercholesterolaemia, diabetic retinopathy, chronic heart failure, and breast cancer. An x-ray reveals mild joint space narrowing with no evidence of fractures. 

A set of bloods are taken:

Hb 135 g/L (130-180)

MCV 93.5fL (80-96)

WCC 8.0 x 10⁹/L (4.0-11.0)

CRP 2 mg/L (<10)

Sodium 132 (133–146 mmol/L)

Potassium 5.3 (3.5–5.3 mmol/L)

Creatinine 83 (45–84 μmol/ L)

EGFR >90 

LFTs normal 

ESR 1

Rheumatoid factor 5 (0-20 u/mL)

What is the most appropriate next-line treatment for this woman to manage her pain?

Select the SINGLE most appropriate option from the list below. Select ONE option only.