Q. A 58-year-old woman came to your clinic for an exacerbation of knee pain. She has had bilateral hand pain for the past two years and left knee pain for the past two weeks. The knee pain became severe three days ago following climbing the stairs. Hand and knee pain intensifies after activities and gets better with rest. She also complains of morning stiffness lasting about 10 minutes. She has a history of medically controlled hypertension and hypothyroidism. Her BMI is 29 kg/mm2. On examination, both hands show swelling and deformities in the distal interphalangeal joints of the first to fourth fingers and the first carpometacarpal joints. Joint swelling is firm and nodular. Passive and active range of motion is reduced and painful in all involved joints. Motor and sensory exams are normal. The left knee has mild effusion with a painful patella. The patellar grinding test is painful. The knee joint is stable, and the clinical alignment is normal. Passive and active range of motion is normal but slightly painful. The rest of the physical examination is not significant. She has been using Advil on an as-needed basis, but now it does not relieve the knee pain. The x-rays of hands show joint space loss, osteophytes, and bone sclerosis in distal interphalangeal joints of the first to fourth fingers and osteophytes and joint subluxation in the first carpometacarpal joints. In the knee x-ray, the only findings are slight joint effusion and small osteophytes around the patellar articular surface. What is the best plan for her?