31st January 2024

A 35-year-old female is referred to the rheumatology clinic by her GP with a two-year history of joint pains initially affecting the shoulder and then extending to the hands, wrists, upper back, hips, thighs and knees.

A 35-year-old female is referred to the rheumatology clinic by her GP with a two-year history of joint pains initially affecting the shoulder and then extending to the hands, wrists, upper back, hips, thighs and knees. She reports morning stiffness lasting 30 minutes. There has never been any swelling or redness of the joints, but everywhere feels generally tender and finds even light touch painful. She feels very fatigued, even when she has a good night’s sleep. Of note, she has recently been diagnosed with irritable bowel syndrome (IBS). She has recently stopped working as a shop assistant due to the symptoms. Routine blood tests, including TFTs, vitamin D levels and autoantibody screen are all normal. An MRI of her shoulder was also performed when these symptoms started two years ago, which was unremarkable. 

Which of the following is the most appropriate management plan?

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