Pain in the left knee, ri...

As her main complaint, a 55-year-old female schoolteacher came to the clinic for assessment and treatment of pain in the left knee, right shoulder, and low back. A rheumatologist had given her ankylosing spondylitis as her diagnosis two years prior. She showed the recognisable radiographic symptoms of sacroiliitis and was seropositive. She has a family history of rheumatoid arthritis. Lab results found to be: positive HLA-B27, positive ANA screen with speckled pattern 1:320, multiple elevated repeat high sensitivity C-reactive protein (hsCRP) levels (5.5, 14.6, 9.9, 3.6, 15.1), elevated thyroid peroxidase antibodies (38), ALT 48, elevated thyroglobulin antibodies 4.1, elevated serum ferritin 277, hyperlipidemia, and low sodium 133.