Results of labs, x-rays come back

Your patients comes back to your office with results of the labs and x-rays your ordered. 

Labs are indicative of inflammation and x-rays of the knees show narrowing of joint space, mainly on the left knee, bone spurs' formation on both knees. You think that you now have more data on your original diagnosis of knee OA and a referral to a rheumatologist might be a good idea. 

In your patients' labs you notice that his liver enzymes are elevated, almost to a double, and you ask about doses and use of his pain medication. He says that he only takes pain pills when he is in pain. Still, you are a bit hesitant to his liver enzymes. You make sure that you repeat the correct way to use the pain medication and you discuss the next steps on pain interventions and managing OA of the knees. 

You refer to a rheumatologist and arrange for a follow up visit in a month's time.