A rheumatologist is called to the hospital to see a 60-year-old male patient with rheumatoid arthritis two days after an uncomplicated total knee replacement.
The patient is expected to be discharged the following day, but the knee is still slightly swollen. The patient reports some discomfort in the operative knee when pressure is placed on it. He states the pain is tolerable with some oral hydrocodone/acetaminophen and denies any other complaints. He shows signs of weight loss since his last visit with the rheumatologist. His nonsteroidal antiinflammatory drugs (NSAIDs) and methotrexate were discontinued one week preoperatively. Currently he is on aspirin for thrombosis prophylaxis and an intermittent pneumatic compression device, ordered by the orthopedic surgeon. The orthopedic surgeon has also ordered a visiting nurse and physical therapy after discharge.
At the time of the examination, the patient is alert and oriented. His vital signs are normal, and his lungs are clear. His heart has a regular rate and rhythm with no murmurs or friction rubs, and he has good peripheral pulses. His abdomen is soft and nontender with no masses or hepatosplenomegaly. The surgical dressing on his right knee is dry and intact, with a knee immobilizer and intermittent pneumatic compression device in place. The patient has slight decreased extension in his right elbow, bony proliferation, and mild Boutonnière deformities in fingers.
The patient was instructed to schedule a follow-up office visit in three weeks with the rheumatologist and will restart NSAID and methotrexate therapy once cleared by the orthopedic surgeon.
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