Step 2

Rheumatology 3

A 28-year-old man with no significant medical history presents to his primary care physician complaining of intermittent low back pain for the past 4 months. He says the low back pain is worse in the morning along with stiffness lasting approximately one hour which improves as the day goes on. On physical examination, performing a forward bending test shows no unevenness in the spine and ribs, but spinal flexion is moderately limited. Straight leg raise test is negative bilaterally. Sensation is intact in the bilateral legs with no numbness or tingling. The patient denies recent fever, weight loss, waking up at night due to pain, urinary retention, or bowel incontinence. He also denies any other symptoms currently. Initial x-rays of the lower spine and pelvis show no evidence of obvious spinal changes or sacroiliitis.

Which of the following is the most appropriate next step in management of this patient?

  • A) Order Anti-histone antibody
  • B) Order erythrocyte sedimentation rate and C-reactive protein
  • C) Order MRI of the spine
  • D) Order rheumatoid factor/anti-CCP antibodies
  • E) Refer to physical therapy


Yunjia Shen


Dr. Raj Dasgupta