13th February 2025

A 34-year-old man presents a 4-month history of lower back pain which is significantly worse in the mornings.

A 34-year-old man presents a 4-month history of lower back pain which is significantly worse in the mornings. He has a history of depression for which he takes fluoxetine. He smokes around 25-30 cigarettes per day and drinks around 22 units of alcohol per week but states he is cutting this down.

He mentions that 3 weeks ago, he developed a painful left eye, which resolved after around a week, but otherwise has had no fevers, sore throat or rashes. He states that for the last 2 weeks he has been using ibuprofen regularly, which seems to have helped significantly, but he is wondering about other treatments. In addition to further investigations, which of the following should firstly be considered for this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.