Sprint 31: When First Line Isn’t an Option

Case

Refer directly for total knee replacement

Begin an oral NSAID along with activity and exercise-based management

Avoid treatment until repeat imaging confirms progression

Determine whether the diagnosis is correct

Prevent further structural degeneration of the joint

Reduce knee pain enough to improve or preserve function

It makes symptom treatment unnecessary because another problem is more important

It makes the original treatment strategy less attractive because its potential harm is now greater for this patient

It means osteoarthritis is no longer the most likely explanation for the knee pain

It adds relevant medical information, but the original treatment plan remains appropriate

Stop treating the knee pain until kidney function improves

Continue the oral NSAID because it remains an appropriate treatment for knee osteoarthritis

Revise the plan to use a topical NSAID with exercise-based management, considering additional symptom-directed options as needed

Proceed directly to surgery because medication options are now limited

Any alternative is preferable once a problem with the original treatment is identified

It is considered second-line therapy, so it should automatically replace first-line treatment

It still addresses his pain and functional goal while reducing exposure to the risk that made the original plan less suitable

His kidney disease means symptom treatment should now be minimized regardless of his functional goals