A 60 year-old male obese patient who recently retired as a d…

A 60 year-old male obese patient who recently retired as a delivery truck driver presents with chronic pain of the low back that is worse in the morning.  Physical examination elicits tenderness over the low back, and he also has some chronic hand pain. Hand x-ray findings of Heberden’s nodes and lumbar x-ray findings of osteophytes confirm the diagnosis of