26th January 2024

A 60-year-old male presents to rheumatology clinic with a 1-year history of progressive back pain.

A 60-year-old male presents to rheumatology clinic with a 1-year history of progressive back pain. He describes pain which is worse in the evening, particularly after a long day of work as a carpenter. He also describes some stiffness in the back in the morning, but says that this resolves slowly once he gets out of bed. He is otherwise fit and well, and does not report any weight loss or systemic symptoms. He does not recall any history of trauma. On examination, he has mild tenderness on palpation of the back, but nil else of note. His blood test results are as follows:

Hb 108 g/L (115-165)

MCV 82.5fL (80-96)

WCC 6.0 x 10*9/L (4.0-11.0)

CRP 8 mg/L (<10)

U&Es normal  

LFTs normal 

ESR 2

Rheumatoid factor 32 (0-20 u/mL)

Anti-CCP negative 

What is the single most likely diagnosis in this man?

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