A 74-year-old woman has pain in her right hand and lower back, which started months ago, and is now interfering with her activities of daily living. The pain gets worse as the day progresses. There is no history of any trauma, and she is otherwise well. Taking over-the-counter acetaminophen usually relieves the pain. On examination, there is bony soft tissue swelling of her second and third DIP joints in the right hand and pain in her lower back on forward flexion. There is no erythema or joint effusion in any of the other joints. Which of the following is the most likely explanation for the joint pain of osteoarthritis?
Osteophytes can cause pain by stretching periosteal nerve endings. Synovial inflammation is frequently seen in osteoarthritis, but not in ligament inflammation. Microfractures, but not macro-fractures, commonly cause pain. Muscle spasm can be an important factor in the joint pain.
synovial inflammation is not the cause
ligament inflammation is a common cause
clinically visible (via plain x-ray) fractures are a common cause of pain
osteophytes can cause pain
Immunology and Rheumatology