Advanced case, what’s causing it?

I met with an orthopedic hand surgeon today. He looked at my x-rays & said my arthritis is really bad for my age (50/F). Said something is going on in there. Inflammation. That I could probably get a referral from my PCP to a university where they treat advanced cases like mine.

Anyone here have experience what could be causing this?

Rheumatologist thinks it’s caused by Hashimoto’s antibodies. I’m negative for Rheumatoid. I’m ANA positive. I’m going to ask tomorrow if rheumatologist can order more labwork & test for other suspected causes. 🤷‍♀️