A 60-year-old male patient with rheumatoid arthritis on traditional Medicare was admitted to the hospital for a right knee replacement surgery. Because of the patient’s rheumatoid arthritis, the admitting physician requested that his rheumatologist see him before surgery. The rheumatologist last saw the patient one month ago in her office. The patient reports he is having some dull pain in the operative knee, but the pain is tolerable with some oral hydrocodone/acetaminophen. The patient denies any other complaints. His discomfort is at a level seven. His nonsteroidal, antiinflammatory drugs (NSAIDs) and methotrexate were discontinued one week preoperatively. He is on Lovenox for thrombus prophylaxis and an intermittent pneumatic compression device ordered by the orthopedic surgeon. The orthopedic surgeon 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. His lungs are clear, and his heart has regular rate and rhythm, no murmurs or friction rubs. He has good peripheral pulses. His abdomen is soft, nontender, and has 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 right elbow, bony proliferation, and mild boutonniere’s deformities in fingers.
He was requested to schedule a rheumatology follow-up office visit in three weeks, and will restart NSAIDs and methotrexate once cleared by the orthopedic surgeon.
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