Approach to joint pain and swelling Quiz: Ace Your Exams

A 79-year-old woman presents to the primary care clinic to establish care. Over the past few months, she has had pain in the left knee that is worse when walking up and down stairs. She also has occasional pain in the right hip from prolonged walking and has pain and stiffness in both hands with a few bony growths noted. Both hands are stiff in the mornings, lasting 5 minutes. The pain in all joints is worse at the end of the day after hours of gardening. Past medical history is significant for dyslipidemia and hypertension, well-controlled with atorvastatin and losartan, respectively. Vital signs are unremarkable. On physical examination, the distal interphalangeal joints of two fingers have bony hypertrophy with limited range of motion but no erythema or swelling. The left knee has minimal effusion without erythema or warmth. There is medial joint line tenderness, limited range of motion, and crepitus with movement. There is a reduction in passive range of motion of the right hip. Serum complete blood count is within normal limits. Serum uric acid level is 8.4 mg/dL (reference range: 3-8.2 mg/dL). What is the most likely diagnosis?