History

Susan presents with a long history of recurrent mid back pain. She states that it has been going on for years and is progressive. The pain is now present constantly and can be quite debilitating. She denies any specific trauma, difficulty breathing, recent respiratory infections or chronic lung disease. Prior diagnoses include strain / sprain and postural syndrome. Prior physical therapy has occasionally provided transient relief but the pain returns. The pain does not correlate with activity level but does seem to be more prevalent with standing and relieved by lying down. She reports recurrent episodes of other musculoskeletal pain, primarily affecting the extremities. These have been transient and have typically responded to OTC analgesics. She states that she frequently sprains her ankles and wrists. She reports daily headaches with a weekly, “migraine.”

Susan is a non-smoker. She does not exercise on a regular basis. She is currently on a course of antibiotics for an intestinal infection. Susan had cataract surgery at age 46.

Question: Based on the history what are some differential diagnoses you are considering?