Catching the culprit of this pain and morning stiffness

A wide diagnostic net is cast to catch the culprit behind this patient’s inflammatory symptoms

Alan is a 73-year-old man who presents with a 2-3-week history of aching shoulders, hands, legs and hips.

He reports the pain is movement-related, particularly when raising or lowering his arms or getting up from a chair.

He experiences no pain at rest or while lying in bed. The pain improves with movement and walking.

He also complains of morning stiffness lasting 15–20 minutes, and has difficulty putting on shoes and lifting his legs.