Chronic low back pain Quiz: Ace Your Exams
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A 32-year-old man presents for evaluation of two-years of intermittent low back pain and stiffness. He reports that the symptoms are worse in the morning and last for over an hour. The back pain improves with physical activity. Recently, the pain has become more persistent and occasionally awakens him at night. He has also noticed occasional pain in the right heel and mild fatigue. He has not had recent trauma, radicular symptoms, bowel or bladder dysfunction, or recent infections. Vitals are within normal limits. On physical examination, there is pain with lumbar spine flexion and extension, as well as tenderness to palpation over the sacroiliac joints bilaterally. There is tenderness and swelling of the right Achilles tendon. Straight leg testing is negative bilaterally. There is no peripheral joint swelling pain, tenderness, or deformities, and there are no skin rashes. Neurological examination is normal. Laboratory results are shown below. Which of the following is the most likely diagnosis?
| Laboratory value | Result |
| Hemoglobin | 12.5 g/dL |
| White blood cell | 7,800/µL |
| Platelet | 310,000/µL |
| Erythrocyte sedimentation rate (ESR) | 45 mm/hr |
| C-reactive protein (CRP) | 25 mg/L |
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