Anita (55 years old)

Anita is a 55-year-old housewife suffering from fibromyalgia with severe right knee pain, chronic pain in the back, shoulders, thighs and hips, and pain to the typical tender points.

In her medical record, the following is noted:

• Obesity (BMI: 33)
• Bilateral genu valgum worsening over time
• Depression

Previous investigations:

• Laboratory results: within normal ranges
• Knee X-ray: narrowing of the intra-articular space
• Knee ultrasound: normal ligaments without effusion
• SPECT nuclear scan: severe OA

Her medications include analgesics, etoricoxib, duloxetine and pregabalin.

Without history of physical trauma, an effusion appeared last year, which was confirmed by MRI to be due to lateral meniscal injury, osteophytes, cartilage thinning and other degenerative changes. Fragments of cartilage and meniscus were removed by arthroscopy, but since the surgery, Anita complains of continuous and even nocturnal pain.

She is very frustrated about the poor outcome of the arthroscopy as her knee is stiff and she can hardly walk, so she comes to you asking for a solution.