An 80-year-old woman complains of feeling generally fatigued and experiencing muscle aches. She reports stiffness and pain in her back, arms, and thighs, especially in the morning. These symptoms have persisted for the past two weeks, despite her previously being in good health. Upon examination, the only notable finding is tenderness in her deltoid and thigh muscles, with normal muscle strength. What is the probable diagnosis?
A 35-year-old man visits his GP complaining of joint pains. He reports experiencing pain in his hips and legs, but his primary concern is his back pain. He notes that he feels very stiff in the morning, but this improves with exercise. The GP is contemplating conducting tests for ankylosing spondylitis. What characteristic would provide the strongest evidence for this diagnosis?
A 67-year-old man with a history of type 2 diabetes mellitus and peripheral arterial disease presents with fatigue and unexplained fever. He underwent a left toe amputation recently and is suspected to have osteomyelitis in the affected foot. What investigation would be most suitable for confirming the diagnosis?
A 56-year-old male with chronic back pain presents with new onset bilateral leg pain which radiates bilaterally down the back of his thighs and legs. He denies any strenuous activity over the past few days and has not been performing any activities outside his daily routine during which he works as a librarian. He reports to have noticed some mild perianal reduced sensation in the past few days. He has no other past medical history of note and only takes ibuprofen as a regular analgesic for his back pain.
Observations show:
Blood pressure: 149/86 mmHg
Pulse: 92bpm
Temperature: 36.9ºC
Respiratory rate: 20/min
Oxygen saturations: 99% in room air
On examination, he is noted to have hyporeflexia in both ankles and some reduced dorsiflexion in his right foot – neurological examination is unremarkable. Per-rectum examination shows no loss of anal tone.
What is the most likely diagnosis?
Karen is a 55-year-old woman who has late ankylosing spondylitis. What pulmonary feature might you observe on her chest X-ray?
A 65-year-old woman came to see her GP due to severe fatigue and muscle pain in her shoulders and hips. The symptoms began three weeks ago and have progressively worsened. Although she can still climb stairs, it causes her pain. She also experiences stiffness, particularly in the morning, which improves throughout the day. She denies any joint swelling or rash and shows no signs of muscle wasting upon examination. What findings suggest a diagnosis of polymyalgia rheumatica?
A 45-year-old shop stocking agent presents to her GP with complaints of pain in both wrists and numbness and tingling at night. She reports needing to shake her wrists in the morning to regain feeling in her fingers. Upon examination, there is no evidence of neurovascular compromise in her hands, but Phalen’s test is positive. Grip strength is reduced, and wrist range of motion is normal. What is the recommended initial treatment?
A 32-year-old man has been diagnosed with ankylosing spondylitis after presenting with a six-month history of back pain. Upon examination, there is limited lateral flexion of the spine but no other complications are evident. What is the most probable first-line treatment that he will be offered?
A 16-year-old boy comes to his GP complaining of lower back pain that has been bothering him for the past 3 months, particularly in the mornings. An x-ray of his lumbar spine reveals sacroiliitis, but no other joints are affected. What is the best initial course of action while waiting for a referral to rheumatology?
John is a 70-year-old man who is retired. Lately, he has been experiencing stiffness in his fingers while playing guitar. He also notices that his fingers ache more than usual during and after playing. John used to work as a computer programmer and does not smoke or drink alcohol. His body mass index is 30 kg/m². What radiological findings are most indicative of John’s condition?