Intended for healthcare professionals

Clinical Review Interactive case report

A 64 year old woman with knee pain: case presentation

BMJ 2004; 328 doi: (Published 03 June 2004) Cite this as: BMJ 2004;328:1362
  1. Peter Tugwell, professor of medicine (,
  2. Annette M O'Connor, senior scientist, clinical epidemiology2,
  3. Nancy A Santesso, knowledge translation specialist3
  1. 1Department of Medicine, University of Ottawa, 202-1 Stewart Street, Ottawa K1N 6N5, Canada
  2. 2Ottawa Health Research Institute, Ottawa Hospital, 1053 Carling Avenue, Ottawa, K1Y 4E9, Canada
  3. 3Cochrane Musculoskeletal Review Group, University of Ottawa
  1. Correspondence to: ptugwell{at}

    Mrs Patell is a 64 year old woman with osteoarthritis of the right knee. A year ago, her general practitioner had recommended up to 4000 mg/day of paracetamol (acetominophen) for pain localised at the medial compartment of the knee. Mrs Patell had been taking the paracetamol but had forgotten that her general practitioner had mentioned that it should not be taken with alcohol. She has recently seen a newspaper article warning people about the risks of chronic use of analgesics. The article warns against liver damage when taking high doses of paracetamol in association with alcohol.

    After reading the newspaper article she became worried, because she enjoys a cocktail before dinner and shares a bottle of wine while eating with her husband. She knew she needed to take something; her pain was intolerable with lower doses and the pain also limits her abilities to help her husband with routine tasks around the house.

    This case is fictional but was developed from several real cases. …

    View Full Text

    Log in

    Log in through your institution


    * For online subscription