A 30-Year-Old Man Comes to the Office Due to Low

question 1292

Multiple Choice

A 30-year-old man comes to the office due to low back pain and stiffness for 2 months.  His pain is worse in the morning and improves with activity.  The patient has also had intermittent diarrhea and lower abdominal pain for the past 3 months.  He tried ibuprofen, which helped his back pain but made his diarrhea worse.  He has not traveled outside the United States.  The patient has been sexually active with the same female partner for 2 years.  He has no other medical problems and does not use tobacco, alcohol, or recreational drugs.  Vital signs are normal.  Physical examination shows limited spine flexion and tenderness in the lower back.  Laboratory studies show anemia and thrombocytosis.  Stool cultures are negative.  Plain radiographs reveal sacroiliac joint inflammation.  Which of the following is the most likely cause of this patient's symptoms?

• A)Celiac disease
• B)Inflammatory bowel disease
• C)Paraneoplastic syndrome
• D)Reactive arthritis from diarrhea
• E)Rheumatoid arthritis
• F)Spinal osteomyelitis

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