A 68-year-old man with a history of type 2 diabetes and chronic obesity presents to an outpatient consultation office complaining of persistent, severe bilateral knee pain that has worsened over the past several years. He reports daily use of over-the-counter ibuprofen, which provides only temporary relief and has recently caused him some intermittent upper abdominal discomfort. His vital signs upon presentation are: temperature 36.7°C, blood pressure 168/98 mmHg, pulse 76/min, respirations 14/min, and oxygen saturation 97% on room air. Physical examination reveals firm, bony enlargements at the distal interphalangeal and proximal interphalangeal joints of both hands. There is crepitus and mild tenderness on palpation of both knees, with a reduced range of motion. Radiographic images of the knee show prominent findings of asymmetrical joint space narrowing, subchondral sclerosis, and osteophyte formation. Given this presentation, what is the most likely diagnosis and the recommended initial step in long-term management?

A 62-year-old female retired nurse presents to a general medical clinic with insidious onset of right knee pain. She reports the pain has been progressively worsening over the past two years, exacerbated by prolonged standing, walking, and climbing stairs, and often improves with rest. She experiences morning stiffness lasting about 15-20 minutes, which improves with activity. She denies any specific trauma, locking, or giving way. Her past medical history includes type 2 diabetes mellitus well-controlled on oral medications and controlled hypertension. She is overweight. On physical examination, her right knee has mild effusion with no warmth or significant erythema. There is crepitus noted with passive and active range of motion, which is mildly restricted at terminal flexion and extension. There is no tenderness along the joint line or collateral ligaments. Cruciate ligaments appear stable. The patient ambulates with a slight limp. Given this presentation, what is the most probable diagnosis and the cornerstone of her long-term non-pharmacological management?

A 72-year-old woman presents to her family physician reporting persistent joint discomfort that has progressively worsened over the past several years. She describes the pain as primarily affecting her knees and hips, and intermittently her first metatarsophalangeal joint. The discomfort is consistently aggravated by prolonged standing or walking and significantly improves with rest. She also notes a sensation of grinding or clicking in her knees during movement. Her past medical history includes type 2 diabetes mellitus, controlled hypertension, and a body mass index (BMI) of 34 kg/m². She previously worked as a long-distance truck driver for 30 years. On physical examination, there is palpable crepitus with range of motion in both knees and hips, and mild tenderness to palpation over the medial joint line of the knees. No significant warmth or erythema is noted in any joint. Given her clinical presentation, what is the most likely diagnosis and the most appropriate initial non-pharmacological management recommendation?

A 60-year-old man presents to his primary care provider's office reporting persistent discomfort and stiffness in his finger joints for the past 18 months. He describes the pain as a deep ache, predominantly affecting the ends of his fingers and the base of his thumb, intensifying throughout the day, particularly after prolonged activity or in the evenings. He also notes a characteristic stiffness upon waking, which typically resolves within 20 minutes of gentle movement. He denies any systemic symptoms such as fever, generalized fatigue, skin rashes, or oral ulcers. His medical history includes a long-standing managed case of gastroesophageal reflux disease (GERD) with a prior episode of a bleeding gastric ulcer. He has a family history of an autoimmune condition, with his maternal aunt having rheumatoid arthritis, which causes him some apprehension. On physical examination, there is mild bony enlargement and tenderness noted bilaterally at the distal interphalangeal (DIP) joints and the first carpometacarpal (CMC) joints, with no significant warmth or erythema. There is also slight deviation of some distal finger joints. What is the most probable diagnosis and the cornerstone of initial pharmacologic management for this patient?

A 67-year-old woman presents to her primary care physician with a 10-month history of progressive right hip and groin pain. The pain is dull, aching, and significantly worsens with activity, particularly after prolonged standing or walking, and provides some relief with rest. She describes morning stiffness lasting approximately 20 minutes, which gradually improves with movement. Her medical history is significant for well-controlled type 2 diabetes mellitus, hypertension, obesity (BMI 32 kg/m²), and a remote history of an episode of acute kidney injury from which she fully recovered. Current medications include lisinopril, metformin, and occasionally over-the-counter acetaminophen for pain. She recently attempted to increase her physical activity, including light walking, but found it exacerbated her hip discomfort. On physical examination, she is an overweight woman with an antalgic gait. Palpation over the right hip joint elicits tenderness. Passive and active range of motion of the right hip is limited, especially internal rotation and abduction, with palpable crepitus during movement. Her vital signs are stable: temperature 37.0°C, blood pressure 138/88 mmHg, pulse 70/min, respirations 14/min. Given these findings, what is the most likely diagnosis and the most appropriate initial non-pharmacological management strategy?