<s>[INST] Odetta Holmes, a 68-year-old African-American woman, complains of joint pain. During a medical interview, she reports lower back pain and stiffness that began about 10 years ago, follows her into the morning, and worsens as the day progresses. She has tried ibuprofen. The pain is relieved somewhat by exercise, but Odetta is "not a fan" of exercise. The patient mentions that despite treatment, she continues to wake up at least two to three times a night with low back pain. She also mentions a family history of ankylosing spondylitis. The patient has diabetes and hypertension for which she takes metformin and losartan. The pain she is experiencing is substantial; she rates it a 7 on a scale of 1-10. What elements of onset, duration, aggravating, relieving, quality, severity, timing, and progression provide clues for a diagnosis?[/INST]