The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
Six months ago, a 58-year-old woman presented with a 1-year history of bilateral sternoclavicular joint swelling and stiffness. She reported mild pain and stiffness of her shoulders and upper back as well as 1-2 hours of morning stiffness that lessened by the end of the day. Ibuprofen provided partial relief. Working out also helped alleviate her symptoms; however, the affected joints became sorer. Although she noted dryness in her eyes upon waking up in the morning, she did not use artificial tears regularly.
She presents for follow-up 6 months later. The bilateral sternoclavicular joint pain and swelling resolved completely with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). However, she reports worsening of her bilateral shoulder pain, with restriction of range of motion. She cannot abduct her left shoulder beyond 30-40 degrees. The patient had no previous restriction of range of motion. She also has significant bilateral knee pain and stiffness, especially in the morning, as well as morning stiffness in her lower back and sacroiliac joints that increases by evening. She notes partial relief with ibuprofen 200 mg twice daily and acetaminophen once daily.
Her family history is negative for any significant autoimmune diseases. She has no family history of psoriasis. She does not smoke tobacco, drink alcohol, or use illicit drugs. She has no history of prior surgeries. The results of a recent colonoscopy were normal. The patient was previously healthy before her current symptoms developed, and she has no significant past medical history. A detailed review of system is negative for any history of seizures, strokes, Raynaud phenomenon, dry mouth, mouth sores, nausea, vomiting, breathing problems, or heart disorders.
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Cite this: Kristine M. Lohr, Muhammad Sohail Khan. Morning Stiffness, Dry Eyes, Back Pain in a Fit 58-Year-Old - Medscape - Nov 10, 2022.