a 43-year-old woman presents with stiffness and pain in her fingers. it takes her about an hour in the morning to be able to use her hands. the symptoms started occurring about 3 months ago, and they have gradually worsened. recently, she also realized that some of her finger joints were swollen. she has a 2-year history of knee pain when climbing stairs. the patient's medical history includes hypertension, hyperlipidemia, and coronary artery disease. her current medication is aspirin (81 mg daily), celecoxib (600 mg daily), glucosamine (500-mg tid), niacin (3 g/day), simvastatin (10-mg qh), vitamin e, and a multivitamin supplement. admission vital signs are temperature 98.5° f, blood pressure 145/85 mm hg, pulse rate 80/min, and respiratory rate 20/min. physical examination reveals a well-developed, well-nourished woman in no apparent distress. physical examination is unremarkable except for swelling around metacarpophalangeal and proximal interphalangeal joints of the 2nd to 4th finger on both sides. thå-ºò0â/ere are no skin alterations. admitting laboratory values are white blood cell count: 26,900/mm3; hemoglobin: 14.9 g/dl; hematocrit: 44.4%: platelet count: 152,000/mm3; and crp: 29mg/l. x-rays taken of both hands and knees show juxta-articular osteopenia, bone erosions, and loss of articular cartilage. question: what is the most likely diagnosis?
