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A 56-year-old man is evaluated for a 2-year history of mid to lower back pain and stiffness. He reports no buttock pain. He has tried home-based exercises, with minimal benefit.
On physical examination, there is diffuse tenderness to palpation of the lower thoracic spine and upper lumbar spine, with reduced flexion and extension. There is no sacroiliac joint tenderness.
Laboratory evaluation reveals a normal blood C-reactive protein level.
Radiograph of the spine is shown. Sacroiliac joint radiographs are normal.
