PAIN IN KNEE
Old man or woman with knee pain = osteoarthritis
1.    Oint. Methyl Salicylate locally (counterirritant = 3D-1)
Or DicloNAC Gel locally TDS (NSAID Ointment =3D-2,3,&4)
2.    Foment with Hot Water bag.
3.    Tab DicloNAC – 501 tds x 7 x after food (DiclofeNAC =3c-9) or any other NSAID e.g. Ibuprofen, Flurbiprofen, Indomethacin Meftal, PIROX, Tobitil,Nimulid, Suganril etc. (See 3c to 12)
4.    Gelusil MPS A tsp x 3 times x if patient has symptoms of hyperacidity (Antacid/Acid inhibitors = 1A &2B)
If pain is acute and severe, add-
5.    Inj. DicloNAC 1 amp IM x daily x 3 (Injectible NSAID = 3C-1
6.    Tab Wysolone 5 mg x tds x 5 x after food (short course of steroid = 9A-2)
7.    S.W.D (Short Wave Diathermy for 5 to 10 Days.
If there is effusion, which does not subside with above treatment,
1.    Refer to orthopedic surgeon for knee aspiration
If there is localized tender spot
1.    Refer to orthopedic surgeon for local Hydrocortisone injection, but intra articualr L.H.C. should not be given repeatedly, as it may accelerate the process of articular destruction.
Maintenance Therapy
1.    Tab voveron –SR 1 daily ( Long acting preparations of NSAIDs = 3C-1 to 12 e.g. Tab Froben-SR 1 OD, Cap Indocap SR 1 OD, Tab PIROX 20mg. OD, Tab Tobitil 20mg. OD etc) All to be taken after food.
2.    Tab Ranitidin 150 mg. HS (1A or 1B) if gastric symptoms.
3.    Quadruceps Exercises: sit on chair, lift legs without or with small sandbags tied to ankles 20-30 times x 2 times/day.
4.    if patient is obese, weight reduction will work wonders for knee pain.
5.    Use walking stick, to reduce the load on affected knee.
6.    avoid climbing stairs, sitting on flor as far as possible.
7.    Use commode, in stead of Indian style latrine.
What is the choice if the patient has peptic ulcer?
1.    Use (Thrice) least irritant drug e.g. Nimesulide, Meloxicam, Nabumetone.
2.    Prescribe antacids and acid suppressing drug e.g.
(I)    Syr. Gelusil MPS 2 tsp x times/day.
(II)    Cap. Omez 10-20 mg.
3.    Instruct the patient strictly, to take drugs after meals (never on empty stomach) and stop the drug immediately, if epigastric pain or burning appears.
4.    Use local applications more liberally e.g. voveron emugel. PIROX gel or Brufen gel.
5.    Ketopatch (Ketotifen 30 mg patch) applied to skin once daily.
(Read Chapter 25- “Which NSAID should I choose?)

If patient is young,  Rule out other causes like Tuberculosis Ask for – Hb%, WBC, ESR, RA Test, X-ray knee = AP & Lateral
When to refer to a Orthopedic Surgeon?
1.    if no response to routine treatment
2.    if knee is swollen, warm & tender
3.    if there is excessive or large effusion.
4.    if there is wasting of Quadruceps muscle.
Other drugs in treatment of Rheumatoid Arthritis.
If Response to NSAID’s is poor.
1.    Tab Salazopyrin 1.5 to x gm/day x 12 wks.
2.    Tab Chloroquin 200 mg. bd x 2-6 months.
3.    Tab Goldar 3 mg. bd x 3-6 months (Auranofin = Gold compound)
4.    Tab Cilamin – 250 mg. x tds x 6months x 1 hour before food (Done-Penicillamine = used in Wilson’s disease)
5.    Tab Endoxan 50 mg. bd x 3-6 months (cyclophosphamide – immunosuppressant)
Important = Drugs No.3,4, &5 are very toxic & should be prescribed under guidance of an expert Physician only. General Practitioners should never prescribe them.

Oint. Methyl Salicylate
DicloNAC Gel
Tab DicloNAC
Ibuprofen
Flurbiprofen
Indomethacin Meftal
Tobitil
Nimulid
Suganril
Gelusil MPS
Inj. DicloNAC
Tab Wysolone
S.W.D
Tab Froben-SR 1 OD
Cap Indocap SR
Tab Tobitil
Tab Ranitidin
Syr. Gelusil MPS
Cap. Omez 10-20 mg.
Ketopatch
Tab Salazopyrin
Tab Chloroquin
Tab Goldar 3 mg
Tab Cilamin
Tab Endoxan