Points to consider.
Barbara has a typical history of OA. The diagnosis of OA is generally a clinical one and can be made in patients with a typical history without additional lab or imaging studies.
The following are options for management. When considering interventions for Barbara it is important to take her history into consideration and try the intervention that is most likely to improve her knee pain with minimal risk.
Physical activity is probably the most important intervention for Barbara. As well as leading to improvements in her knee pain and function, it can also improve management of her other long term conditions.
Topical NSAIDs might be useful but her CKD should be considered. NSAIDs may be contraindicated because of her age and comorbidities.
Referral for Intra-articular corticosteroid could provide temporary relief for the right knee, but not the left, and has the potential to increase her blood sugar.