HomeAnswersOrthopedician and Traumatologyjoint painI am a 49-year-old hypertensive male with severe joint pain. Please help.

How to treat severe joint pain in a 49-year-old hypertensive patient?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

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Published At October 29, 2022
Reviewed AtNovember 10, 2022

Patient's Query

Hi doctor,

I have joint pain. Kindly look at my attached reports. Please help.

Hi,

Welcome to icliniq.com.

I understand your concern.

Looking into your problem and reports (the attachments are removed to protect the patient's identity), I would diagnose that you got osteoarthritic changes in your knee. Supporting clues in X-ray decreased joint space, formation of new bone, and osteophytes. In addition, it causes pressing into nerve innervation and produces a low TSH (thyroid stimulating hormone), which signifies your hypothyroid status. However, other rheumatological tests like RF (rheumatoid factor), UA (urine analysis), CBC (complete blood count), and serum vitamin D3 are within normal limits.

Some more questions arise in my mind about the problem you have mentioned.

Do you have any underlying diseases? Like hypertension, diabetes, hypothyroid, or hyperthyroid?

How much joint pain do you have?

If it is the knee only, Is it swollen? When is the pain?

Do you have morning stiffness of the joint? Is there numbness in joints or feet, or hands?

Do you have pain in the knee movement in a certain direction?

If you have done any treatment, I would love to know about it.

What is your occupation and your lifestyle, Are you obese?

Waiting for your further reply on this question.

Then I would plan your treatment for this case.

Thank you.

Patient's Query

Hi doctor,

Thanks for your kind reply.

Please find my answer below to every question.

I still need to do my TSH test. There is some confusion.

I am hypertensive, and my average BP remains 117/76 mm Hg, maximum, 126/81 mm Hg. I take Aten-25 in the morning.

Almost every joint of mine is paining.

It is not swollen. Pain is more when I exert more than in regular activities.

No morning stiffness and numbness, but sometimes my finger joints pain. Which is sometimes.

I walk 30 minutes in the morning and 20 minutes in the evening. But at 15 minutes, I feel tired in my knees and feel a little discomfort.

I have not done any treatment.

I am running a business, active, and always keep moving.

My weight is 78 kg, and my height is 179 centimeters.

My age is 49.

Thank you.

Hi,

Welcome back to icliniq.com.

I saw all your reports (the attachments are removed to protect the patient's identity); TSH was not yours. You do not have any issues with thyroid diseases. But I can see a problem mainly in your knee joints from the X-ray. It is grade II osteoarthritis changes, and you might too have it in other joints, tiny ones like the hand, fingers, and foot. You got HTN (hypertension), but it is controlled with drugs. Your vitamin D3 is normal.

I want to explain OA (osteoarthritis) and what and why it is causing you. After that, I can give you some knowledge about the illness and its factors.

Finally, I will suggest the best treatment protocol.

OA involves bone, synovium, joint capsule, and the most changes in the articular cartilage. Joint degeneration occurs in athletes and young individuals through damage to articular cartilage caused by repetitive impact and loading.

Sports that cause direct, blunt trauma to joints (such as football, running, soccer, hockey, lacrosse, and rugby) most impact damage.

Prevalence of OA of knee and hips are higher in former athletes than non-athletes (odds ratio of 1.9).

Athletes' higher loading rate and frequency of impact increase the amount of disruption and damage to joint cartilage goal of treatment.

The main goal of treatment in OA is to minimize pain and improve functionality. Active athletes are most likely to benefit from muscle-strengthening exercises because they reduce pain, allowing them to return to play. In the athlete, bracing helps with pain and malalignment and may decrease the time necessary to return to play. So, you should wear knee braces made with silicon.

The treatment modality for OA is intra-articular injection with corticosteroids and viscosupplementation with hyaluronic acid. We can get one shot of hyaluronic acid in the market. It helps your knee joint to lubricate and reduces OA changes, and we will also supplement HA with collagen supplements.

Suplasyn 1-shot (Sodium hyaluronate)is intended to be a single administration. Up to six months, clinical effect on pain and functionality. Any orthopedic surgeon can give this injection. It is just interatrial into the knee joint.

Tablet Gluc-Msm-Chon-Bos-Hyal (Glucosamine, Chondroitin, and Methylsulfonylmethane (MSM) tablet, Extended Release 12 Hr) one tablet taken in oral twice daily for three months.

I hope you find it helpful.

Kind regards.

Patient's Query

Hi doctor,

I want to give a few more details about my issues with bones.

1. My legs are continuously paining.

2. Sometimes both tibias are paining.

3. If I do a little exercise, my hip joint is paining.

4. Pain in hand joint sometimes.

5. I have issues with my back and neck.

My humble submission is that we are trying to treat knee joint, and we should take a holistic approach so that all joints are addressed.

Please take me out of this mess (pain).

Thank you.

Hi,

Welcome back to icliniq.com.

You have done an X-ray of the knee, which shows a moderate type of osteoarthritis changes, which means joint space is much less, and new bone formation has pressed the nerve.

Also, in other joints, similar things can be there.

That one-shot injection will help the knee. The knee is the major joint that helps locomotion.

And I have also planned and given the drug that helps all joints and bones to increase the amount of lubricant in it. So this is an integrated and holistic approach.

I hope you find it helpful.

Kind regards.

Patient's Query

Hi doctor,

Thank you.

Hi,

Welcome back to icliniq.com.

I hope I can make you understand your problem.

If you still have some queries in your mind, please always feel free to communicate with me.

I would also suggest doing simple aerobic exercises.

I hope you find it helpful.

Kind regards.

Patient's Query

Hi doctor,

Thanking you very much from my core being.

Tomorrow I have asked for an appointment with the doctor for an injection. Forgot to mention very often, I feel hot flashes in my feet.

Thanking you.

Hi,

Welcome back to icliniq.com.

That one-shot injection is best for you in your present condition.

I hope you find it helpful.

Kind regards.

Patient's Query

Hi doctor,

Can I get a prescription?

Hi,

Welcome back to icliniq.com.

I suggest,

1) Tablet Gluc-Msm-Chon-Bos-Hyal one tablet oral twice daily for three months.

2) Suplasyn 1-shot 6 mg or 6 mL (Sodium hyaluronate solution) interatrial in the affected knee.

3) Silicon knee brace.

Follow up as needed.

Thank you.

I hope you find it helpful.

Kind regards.

Patient's Query

Hi doctor,

Thank you very much.

Hi,

Welcome back to icliniq.com.

I hope you find it helpful.

Kind regards.

Patient's Query

Hi doctor,

I have started the medicine. Feeling much better. Thanking you.

Hi,

Welcome back to icliniq.com.

I am very happy to know that you got medicine and the treatment is being done. Sure, you will feel very much better after it.

Kind regards.

Patient's Query

Hi doctor,

My knees are behaving well. Now I can walk 30 minutes with little heaviness. But after the injection. It is observed that my knees get hurt while climbing or going down the staircase. Please suggest to me which kneecaps I should use.

Hi,

Welcome back to icliniq.com.

I suggest you do once again an X-ray of the knee.

That one shot injection we can repeat every three months if required too.

Also happy to know you can walk more than before.

Deal with a silicon knee brace that is very nice and supportive when climbing up.

1) Tablet Gluc-Msm-Chon-Bos-Hyal one tablet oral twice daily for three months.

I hope you find it helpful.

Kind regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Santosh Kumar Bashyal
Dr. Santosh Kumar Bashyal

Orthopedician and Traumatology

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