A 42-year-old woman presented to GP with sudden onset of acute back pain followed by more sustained but less severe pain over the next 1 week. The GP assumed that this was a mechanical back pain but carried out some 'screening investigations' which included an erythrocyte sedimentation rate of 4mm in the first hour (normal range <10) and a positive test for rheumatoid factor at a titre of 1 in 256. She was then referred to her local rheumatology department with a possible diagnosis of rheumatoid arthritis. This made the patient considerable anxiety, leading to a certain level of disability.
When she was seen in the rheumatology clinic 3 months later she still had minor back pain, but this was overshadowed by her anxiety. She had no other musculoskeletal symptoms and examination was normal apart from the mild restriction of the lumbar spine. What is the probable diagnosis? Click here for…
