Review Question - QID 212712

A 38-year-old woman comes to the clinic complaining of joint pain for the past 3 months. She often wakes up with pain and stiffness for about 40 minutes. During this time, she is barely able to walk more than 5 steps due to the pain. However, the pain seems to alleviate as the day goes on. She works at a bar and reports that the back pain began several days after she lifted a case of beer. She denies any urinary incontinence, fevers, saddle anesthesia, weakness, or sensory changes. A physical examination demonstrates a skin rash shown in Figure A and joint tenderness of bilateral distal interphalangeal joints (DIP) and the left lower back. What finding would you expect in this patient?