A 58-year-old woman comes to the office with left knee pain. The pain began a year ago and has progressively become more severe. The pain is worse later in the day and is now limiting her normal day-to-day activities. She has no history of injury to the joint and has no significant pain in any other joints. The patient has attempted treatment with acetaminophen, but that has not provided adequate relief. She does not use tobacco, alcohol, or illicit drugs and works as a school bus driver. Her BMI is 34 kg/m². Left knee joint examination shows a mild effusion, crepitus on movement, and joint line tenderness. The patient is started on celecoxib therapy. The presence of which of the following conditions in this patient's medical history would make this medication the preferred treatment?

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11ec160b_3c7a_b9f5_9249_6d55c98a2098_MD0001_00 Cyclooxygenase (COX; prostaglandin synthase) initiates the synthesis of prostanoids (eg, prostaglandins, thromboxane) from arachidonic acid. COX exists in 2 primary forms: Nonsteroidal anti-inflammatory drugs (NSAIDs) work by inhibiting COX to block prostaglandin synthesis. Most NSAIDs inhibit both the COX 1 and COX 2 isoenzymes. However, inhibition of COX 1 may lead to severe adverse effects, including gastric ulceration (reduced mucosal protection) and increased bleeding (decreased platelet aggregation). Selective COX 2 inhibitors (eg, celecoxib) have potent anti-inflammatory effects with less risk of bleeding and gastrointestinal ulceration. They are recommended for use in patients at risk for gastrointestinal complications, such as those with prior peptic ulcer disease. The risk for ulcers can also be reduced by combining a nonselective NSAID with a second drug (eg, proton pump inhibitors, misoprostol) to reduce gastric acid secretion. (Choice A) Selective COX 2 inhibitors do not have a substantial effect on serum lipids. (Choices B and D) Both COX 1 and COX 2 are expressed in renal tissues. Therapy with either nonselective NSAIDs or selective COX 2 inhibitors can cause fluid retention, aggravation of hypertension, and impaired renal function. (Choice E) COX 2 is expressed in vascular endothelial cells and vascular smooth muscle cells, where it plays a role in the local production of prostacyclin, which has anticoagulant and vasodilatory actions. COX 2 inhibitors have been associated with an increased risk of cardiovascular events. Educational objective: Selective cyclooxygenase 2 (COX 2) inhibitors relieve pain with lower risk of bleeding and gastric ulceration than nonselective nonsteroidal anti-inflammatory drugs. __________ References: Comparison of gastrointestinal adverse effects between cyclooxygenase-2 inhibitors and non-selective, non-steroidal anti-inflammatory drugs plus proton pump inhibitors: a systematic review and meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/23208017)

A 58-Year-Old Woman Comes to the Office with Left Knee