A 26-Year-Old Italian-American Man Comes to Your Office for the Evaluation

A 26-year-old Italian-American man comes to your office for the evaluation of low back pain.  He has had this pain for the last eight months, and it is progressively getting worse.  The pain is worse in the morning and gets better as the day progresses.  He denies any history of trauma in the past.  He works as a chef at a local restaurant.  His father and uncles also have "back problems."  His physical examination reveals a limited range of motion of his lumbosacral spine and markedly reduced chest expansion.  The rest of his physical and musculoskeletal examination is unremarkable. Which of the following is the most appropriate statement regarding the prognosis of this condition?

A) Overall mortality is increased in this patient population
B) Most patients will have functional and employment disability
C) Smoking is surprisingly protective in this population
D) Life expectancy is not reduced
E) Prolonged standing at the work place is protective