Intra-articular glucocorticoids are appropriate for this patient. She has osteoarthritis in multiple joints based on her history, physical examination, and plain radiographs. Although her overall osteoarthritis symptoms appear to be well controlled, the right knee is clearly more affected than any other joint. Therefore, therapy targeted toward this joint is indicated, and intra-articular glucocorticoids are the most appropriate choice for this patient to address her localized symptoms. Meta-analyses of clinical trials evaluating the use of glucocorticoid injection in osteoarthritis suggest that the technique may be particularly helpful. Individual studies have shown that the presence of an effusion, withdrawal of fluid from the knee, severity of disease, absence of synovitis, injection delivery under ultrasound guidance, and greater symptoms at baseline may all improve the likelihood of response.

Hyaluronic acid injections have shown only a minimal degree of benefit in the treatment of knee osteoarthritis. They generally require a series of three weekly injections and are more invasive, considerably more expensive, and less predictably efficacious than glucocorticoid injections.

Arthroscopic lavage for knee osteoarthritis is a technique in which fluid is instilled and aspirated from the joint through an arthroscope with the intention of removing the debris often present in these joints. Although observational studies originally suggested that the technique might be of benefit, more recent studies and meta-analyses have suggested otherwise. No differences in pain measured by visual analogue scale or function measured by the Western Ontario McMaster University Index have been identified in controlled trials using sham procedures.

The patient's symptoms are reasonably well controlled on her current NSAID. Therefore, there is no clear benefit to switching to another medication within this class.