Patient case (clinical description): A 66-year-old woman comes to the office due to joint pain in the hands and periodic morning stiffness that lasts less than 15 minutes.  The pain is moderately severe and worsens with daily activity. The patient used Tylenol with minimal relief.  Past medical history is notable for hypertension and hypercholesteremia.  Physical examination shows firm nodules over the distal interphalangeal joints, bilaterally. The patient has pain in her knees as well. The knees are stiff in the morning for less than 30 minutes and become worse with climbing stairs. She has some sensation of bone friction during activity. X-ray shows narrowing of the joint space, subchondral bone sclerosis and osteophyte formation along the joints.

Patient's own account: I'm a 66-year-old woman and I went to my doctor's office because of a bloody joint pain in my hands that has been lasting for a while. The pain comes and go in the morning usually. I feel like a stiffness that last less than 15 minutes. The pain is moderately severe but it gets worse when I'm using my hands. I used Tylenol which helped a little. Apart from that, I suffer from hypertension and high cholesterol. The doctor made me notice that I have bumps around both of my hand joints. I also suffer from my knees and they are also stiff in the morning for around 30 min. It's even worse when I climb up the stairs! I also feel like my bones are rubbing against each other when I'm moving. The X-ray showed that I have narrow joint space, I have sclerosis, and abnormal growths of bone along my joints.

Clinical trial: Persistent Postoperative Pain and Joint Stiffness After Total Knee Arthroplasty Performed for Osteoarthritis

Eligibility criteria:
Inclusion Criteria:

          -  Elective primary unilateral total knee arthroplasty

          -  Osteoarthritis with radiologic evidence of "severe narrowing" and/or "bone on bone" in
             the affected joint

          -  Patients of surgeons who have agreed to participate in the study

          -  Age > 18 years

          -  American Society of Anesthesiologists (ASA) Physical Status 1-3

          -  Regional anesthesia

          -  Epidural patient-controlled analgesia (PCA) for postoperative pain

          -  Adductor canal block for postoperative pain

        Exclusion Criteria:

          -  Contraindication to regional anesthesia, NSAIDs, dexamethasone or acetaminophen

          -  Use of general anesthesia

          -  History of >6 weeks of daily opioid use and/or any use of non-prescribed opioids

          -  Preoperative oral steroid use in the past 6 months

          -  Intra-articular steroid injection within one month of scheduled surgery in affected
             joint

          -  Non-English speakers

          -  Pre-existing diagnosis of rheumatic disease or autoimmune disease (e.g. rheumatoid
             arthritis, psoriatic arthritis, inflammatory bowel disease, multiple sclerosis, Type I
             diabetes)

          -  Peri-articular injections or infusions for postoperative pain

          -  Diagnosis of crystalline arthropathy

          -  Diagnosis of osteonecrosis

          -  Active infection or use of antibiotics

          -  Pregnant women
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.


Eligibility (NLI label): Entailment