A 44-year-old White man presented with a 15-year history of dull midline lower back pain associated with bilateral hip pain. He also noted bilateral hand pain along the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints and prolonged morning stiffness lasting approximately 45 minutes. Family history was notable for a brother with osteoarthritis, hypogonadism, and type 2 diabetes.
Vital signs were within normal limits (heart rate, 92/min; blood pressure, 136/84 mm Hg; respiratory rate, 16/min; oxygen saturation, 97%; temperature, 37.0 °C). Musculoskeletal examination revealed swelling of the second, third, and fifth MCP joints and second and third PIP joints bilaterally as well as decreased knee and hip range of motion with minimal knee effusions. Lower back flexion was decreased with only 4-mm excursion on the modified Schober test. Results of cardiopulmonary, abdominal, neurologic, and dermatologic examinations were unremarkable.