Management of knee osteoarthritis in primary care

Alice, a 62-year-old homemaker, went to your clinic for her routine follow-up for diabetes mellitus and chronic kidney disease (CKD) Stage 3. You advised exercise, as her diabetic control was suboptimal despite her good diet control. She sniggered and pointed to her knees. You noticed bony swelling of her knees and subsequently found out that she has been having knee pain for the last few months and weight gain due to reduction in activity. When you asked her whether she had been taking painkillers for her knees, she said you had previously advised her to be careful with painkillers in view of her CKD.