You are Ade Noma, a 24 year old man who is an avid football player, recently finding it really hard to get up in the morning because of a stiff back.

HPC: Over the last 4 or 5 months you have noticed your lower back is really stiff and painful, especially first thing in the morning – sometimes it even wakes you up it is that bad! It hasn’t been like this every day, but will come on very suddenly when it does. This is very unusual for you, as you’ve never had any trouble with your back before although you have seen the doctor about swelling, pain and stiffness of your right shoulder in the past.

Alongside the back pain, you’ve been more tired than usual, but put this down to starting a new job in a Sport’s shop where you have to get up at 6am every morning. You’ve not particularly noticed, but your partner has made a comment on how you’ve lost a bit of weight over the last couple of months, and come to think of it, the jeans you got for Christmas don’t feel as tight as they had. It’s a bit embarrassing but you are also getting quite a few bouts of diarrhoea and stomach pains recently; your mates have just told you to stop being a ‘sissy’, but they are very painful when you get them and you even noticed a bit of blood the other day. Weirdly, you feel that your back feels better when you don’t rest it, so you’re still playing football lots. Although, after a game last week, you had a really painful heel to top it all off! What’s that all about??

PMH: You used to smoke 10 a day from age of 18 to 20 but haven’t touched a cigarette since. You have struggled with psoriasis since you were 17 which used to really get you down, but seems to be a little more under control now after courses of phototherapy, and you are now just using vitamin tablets.

DH: You’ve just been taking over the counter NSAIDs like ibuprofen but they haven’t really touched the sides. You take Gaviscon when the stomach pains are really bad as Mam thought it could be reflux type symptoms. As mentioned before, you’ve been receiving phototherapy when your psoriasis really bad but now just on Calcipotriol (vitamin D analogue) for most of body and beclomethasone steroid cream for the patches on your scalp.

FH: Your Dad also has very bad psoriasis and has been complaining of stiffness and pain in his hands and feet, but he’s a lot older so you reckon this is just an old age thing – Dad likes to moan a lot about everything anyway! Your Mum mentioned that your Grandfather had very bad posture from quite a young age, and always nags you about sitting up straight.

SH: You do enjoy a binge on the weekends with your football mates. You live at home with your Mam, Dad and little sister but you’re hoping to move into a flat with girlfriend soon when you’ve saved enough from working. Won’t that be a big change!