A 65 yrs old man with H/O back pain since 3 months. ESR is raised. On examination marked stiffness and mild restriction of chest movements is found. On x-ray, syndesmophytes are present in veebrae. Diagnosis is
**Core Concept**
The patient's presentation of back pain, raised ESR, and marked stiffness, along with the presence of syndesmophytes on x-ray, suggests an inflammatory back condition characterized by chronic inflammation and new bone formation.
**Why the Correct Answer is Right**
The patient's symptoms and radiographic findings are consistent with ankylosing spondylitis (AS), a type of seronegative spondyloarthritis. AS is characterized by chronic inflammation of the spine and sacroiliac joints, leading to the formation of syndesmophytes, which are bony growths that bridge the vertebral bodies. The presence of syndesmophytes on x-ray is a hallmark of AS. The patient's raised ESR and marked stiffness are also consistent with an inflammatory process.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect as it does not match the patient's presentation of back pain, stiffness, and radiographic findings of syndesmophytes. While osteoporosis can cause back pain, it does not typically present with raised ESR or the formation of syndesmophytes.
**Option B:** This option is incorrect as it does not match the patient's age and presentation. Degenerative disc disease typically presents in older adults, but it does not typically cause raised ESR or the formation of syndesmophytes.
**Option C:** This option is incorrect as it does not match the patient's radiographic findings. Osteoarthritis can cause back pain, but it does not typically present with the formation of syndesmophytes on x-ray.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that ankylosing spondylitis can present with a wide range of symptoms, including back pain, stiffness, and fatigue. The presence of syndesmophytes on x-ray is a key diagnostic feature, and a raised ESR can support the diagnosis of an inflammatory process.
**Correct Answer: C. Ankylosing spondylitis**