Svenja (54 years old)

Svenja is a 54-year-old secretary with moderate pain in both knees. Her diet is balanced, she maintains a healthy weight, and her medical history indicates primary OA diagnosed 3 years ago.

Since her diagnosis, Svenja has used the full range of pain medications from the analgesic ladder, although opioids were not prescribed on her request. Naproxen was the most effective treatment for pain relief, with minimal side effects. She was also referred to and attended a physical therapy programme, but for the past year she skipped and was less active than usual.

In the last 2 months, her pain became more severe and NSAIDs are insufficient for pain control. She also noticed stiffness and swelling of the knee joints.

On clinical examination you find:

• Oedema at the superior aspect of the left knee joint
• Smaller oedema at the medial aspect of the right knee
• Knees tender to palpation, with crepitus