Clara (53 years old)

Clara is a 53-year-old accomplished art director. She is a non-smoker teetotaller who struggles with obesity (BMI: 38) despite a normal diet and occasional physical activities (swimming and cycling) in her spare time. Her medical history includes a mild skin disorder and mild to moderate asthma, but no metabolic nor endocrine abnormalities.

Three years ago, a fall led to a minor distortion of the left knee (knee sprain), from which she recovered. However, for the past year she has been experiencing serious pain in the same knee while standing and walking, and now also at rest. Three months ago, she was referred to the Orthopaedics Department, but any potential intervention was excluded until achievement of a significant weight loss.

Her medication includes:

• Ibuprofen and paracetamol, >1 year, when needed
• Fluticasone furoate/vilanterol and paroxetin, >2 years

On physical examination, you find that the knee is not swollen and can passively be moved normally, but it hurts along the joint lines.