Differential Diagnosis for Periungual Erythema, Loss of Lunulas, and Fatigue
- Single Most Likely Diagnosis
- Psoriatic arthritis: This condition is characterized by periungual erythema, nail changes (including loss of lunulas), and can be associated with fatigue due to chronic inflammation.
- Other Likely Diagnoses
- Connective tissue diseases (e.g., lupus, rheumatoid arthritis): These conditions can cause periungual erythema, nail changes, and fatigue due to systemic inflammation and autoimmune processes.
- Dermatomyositis: An inflammatory muscle disease that can cause periungual erythema, nail changes, and fatigue, along with muscle weakness.
- Thyroid disorders: Both hypothyroidism and hyperthyroidism can cause fatigue and nail changes, including loss of lunulas.
- Do Not Miss Diagnoses
- Systemic lupus erythematosus (SLE): Although it may not be the first consideration, SLE can present with a wide range of symptoms, including periungual erythema, nail changes, and fatigue, and missing this diagnosis could have severe consequences.
- Sarcoidosis: A systemic granulomatous disease that can cause fatigue, skin lesions, and nail changes, including periungual erythema.
- Vasculitis: Certain types of vasculitis, such as granulomatosis with polyangiitis, can cause periungual erythema, nail changes, and fatigue, and require prompt treatment to prevent serious complications.
- Rare Diagnoses
- Sjögren's syndrome: An autoimmune disorder that can cause fatigue, nail changes, and periungual erythema, although it is less common than other diagnoses on this list.
- Relapsing polychondritis: A rare autoimmune disorder that can cause inflammation of cartilage and other tissues, leading to fatigue, nail changes, and periungual erythema.
- Ehlers-Danlos syndrome: A group of genetic disorders that can cause fatigue, nail changes, and periungual erythema, although this is a less common presentation.