A 65-year-old man had H/o of back pain since 3 months. ESR is raised. He also has dorso-lumbar tenderness on examination and mild restriction of chest movements. On X-ray, syndesmophytes are present in veebrae. Diagnosis is:
**Core Concept**
The question is testing the diagnosis of a chronic inflammatory back condition characterized by the presence of syndesmophytes, which are bony outgrowths that bridge adjacent vertebrae. This condition is associated with significant morbidity and is often linked to ankylosing spondylitis, a type of seronegative spondyloarthritis.
**Why the Correct Answer is Right**
The presence of syndesmophytes, dorso-lumbar tenderness, and mild restriction of chest movements in a patient with a history of back pain is highly suggestive of ankylosing spondylitis. This condition is characterized by inflammation of the spine and sacroiliac joints, leading to pain, stiffness, and eventual fusion of the spine. The raised ESR supports the presence of chronic inflammation.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect as it does not account for the presence of syndesmophytes, a hallmark feature of ankylosing spondylitis. While osteoporosis can cause back pain and vertebral fractures, it does not typically result in the formation of syndesmophytes.
**Option B:** This option is incorrect as it does not consider the chronic nature of the back pain and the presence of syndesmophytes. While acute back pain can be caused by a variety of factors, including muscle strain or herniated discs, the presence of chronic inflammation and syndesmophytes points towards a more serious underlying condition.
**Option C:** This option is incorrect as it does not account for the presence of syndesmophytes and the mild restriction of chest movements. While fibromyalgia can cause chronic pain and stiffness, it is not typically associated with the formation of syndesmophytes or significant restriction of chest movements.
**Clinical Pearl / High-Yield Fact**
The presence of syndesmophytes on X-ray is a key diagnostic feature of ankylosing spondylitis. This finding, combined with chronic back pain and inflammation, should prompt further investigation and consideration of this diagnosis.
**Correct Answer: C. Ankylosing Spondylitis.**