MSRA-1404
A 48-year-old woman visits her GP complaining of back pain that has persisted for 4 weeks despite taking various painkillers. She has a history of coeliac disease and mild vitamin D deficiency, and she smokes 10 cigarettes daily. During the examination, the GP notes tenderness in the T8 vertebrae without any visible deformity, and the patient’s vital signs are normal. There are no abnormalities in her neurological examination. What is the concerning feature in this patient’s presentation that requires further investigation?