Chronic DIP joint pain with radiographic narrowing and nodal changes

A 58-year-old woman presents with a 2-year history of progressively worsening pain in the distal interphalangeal joints of both hands. She reports that stiffness is worst in the evening and after prolonged use of her hands. On examination, there are hard, bony nodules at the distal interphalangeal joints and mild crepitus with movement. Radiographs of the hands show joint space narrowing, subchondral sclerosis, and osteophyte formation at the affected joints. Which of the following is the most likely underlying pathophysiologic mechanism for her condition?

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Chronic DIP joint pain with radiographic narrowing and nodal changes | QWorld.Ai