A55-year-old teacher presents to your health center for evaluation of pain in her wrists. she states that the pain has been present intermittently for several months, but over the last 2 weeks, it has been preset daily. she has taken over-the counter analgesics for the pain, which seem to . she denies fever, chills, or rashes. on physical examination, she has pain and tenderness over the right wrist but not the left. she has a hard dorsolateral nodule on the dip joint of her right middle finger. the mcp joints are normal. what is the most likely etiology of these signs and symptoms?