What is the cause of bilateral knee pain in a patient who received bilateral knee injections from an orthopedic (ortho) specialist and has elevated blood pressure due to non-adherence to blood pressure (BP) medication, and is also requesting a vitamin B12 injection?

From the Guidelines

The patient's elevated blood pressure should be addressed immediately by taking her blood pressure medication as prescribed, and her request for a vitamin B12 injection can be considered after evaluating her current medical status and laboratory results. The patient presents with bilateral knee pain for which she previously received injections from an orthopedic specialist, as noted in the study by 1. She has an outstanding balance of $600 with that provider and plans to follow up after addressing this financial obligation. Today, she is requesting a vitamin B12 injection. Her blood pressure is elevated, which she attributes to not having taken her blood pressure medication yet today. According to the 2017 American College of Cardiology/American Heart Association hypertension guideline, as outlined in the study by 1, the patient's elevated blood pressure requires monitoring and medication adherence counseling to ensure proper hypertension management.

Some key points to consider in the patient's management include:

• Evaluating her current medical status and laboratory results to determine the cause of her elevated blood pressure and to assess her overall health
• Counseling her on the importance of medication adherence to manage her hypertension, as emphasized in the study by 1
• Considering her request for a vitamin B12 injection after evaluating her current medical status and laboratory results
• Addressing her ongoing knee pain and determining the best course of treatment, which may include further orthopedic intervention or alternative therapies, as discussed in the study by 1

The patient's knee pain continues despite previous orthopedic intervention, suggesting ongoing osteoarthritis or another chronic knee condition requiring further management. Her request for B12 supplementation may indicate concerns about energy levels, neurological symptoms, or previous diagnosis of B12 deficiency. By prioritizing her elevated blood pressure and addressing her other medical concerns, we can work to improve her overall health and quality of life.

From the Research

History of Present Illness (HPI)

• The patient is experiencing bilateral knee pain and has previously received injections in both knees from an orthopedic specialist.
• The patient owes $600 to the provider and plans to follow up after the pain has subsided.
• The patient is requesting a B12 injection.
• The patient's blood pressure is elevated due to not taking their blood pressure medication yet.

Relevant Studies

• A study published in JAMA in 2023 2 found that knee osteoarthritis (OA), patellofemoral pain, and meniscal tears are common causes of knee pain, and can be diagnosed clinically.
• A study published in Hospital Practice in 2015 3 emphasized the importance of evaluating the cause of elevated blood pressure in hospitalized patients before initiating treatment.
• A study published in the American Journal of Hypertension in 2001 4 found that rapid adjustment of antihypertensive drugs can produce a durable improvement in blood pressure.
• A study published in the Journal of Clinical Hypertension in 2021 5 compared the effects of different antihypertensive drugs on pain and joint space width in knee osteoarthritis patients.
• A study published in the Journal of Pain Research in 2022 6 presented consensus guidelines on interventional therapies for knee pain, emphasizing the importance of standardizing treatment approaches.

Potential Causes of Knee Pain

• Knee OA, patellofemoral pain, and meniscal tears are potential causes of the patient's bilateral knee pain, as suggested by the study published in JAMA in 2023 2.
• The patient's elevated blood pressure may be related to their knee pain, as suggested by the study published in the Journal of Clinical Hypertension in 2021 5.

Management of Elevated Blood Pressure

• The study published in Hospital Practice in 2015 3 recommends evaluating the cause of elevated blood pressure before initiating treatment.
• The study published in the American Journal of Hypertension in 2001 4 suggests that rapid adjustment of antihypertensive drugs can produce a durable improvement in blood pressure.