Differential Diagnosis for a 76 yo Female with New Onset Migratory Arthritis and Left Upper Extremity Pain
- Single Most Likely Diagnosis
- Rheumatoid Arthritis (RA): This is a common cause of migratory arthritis, especially in older adults. The symptoms of burning pain in the fingers, palm, forearm, and radiation to the medial aspect of the forearm are consistent with the presentation of RA, which often involves the small joints of the hands and can cause pain and stiffness.
- Other Likely Diagnoses
- Osteoarthritis (OA): Although OA is more common in older adults, it typically presents with joint pain and stiffness that is worse with activity and better with rest. However, it could be considered in the differential diagnosis, especially if the patient has a history of joint trauma or repetitive strain.
- Polymyalgia Rheumatica (PMR): PMR is an inflammatory condition that causes muscle pain and stiffness, often in the shoulders, hips, and neck. However, it can also cause pain and stiffness in the arms and hands, making it a possible consideration in this case.
- Giant Cell Arteritis (GCA): GCA is an inflammatory condition that can cause headaches, jaw pain, and visual disturbances, but it can also cause arm and hand pain, especially if the arteries in the arms are affected.
- Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although the patient's symptoms are primarily in the arm and hand, it is essential to consider ACS, especially if the patient has risk factors for cardiovascular disease. The burning pain and radiation to the medial aspect of the forearm could be referred pain from the heart.
- Thoracic Outlet Syndrome (TOS): TOS can cause arm and hand pain, numbness, and tingling, especially if the nerves and blood vessels in the thoracic outlet are compressed.
- Cervical Radiculopathy: Cervical radiculopathy can cause arm and hand pain, numbness, and tingling, especially if the nerves in the cervical spine are compressed.
- Rare Diagnoses
- Relapsing Polychondritis: This is a rare autoimmune condition that can cause joint pain and inflammation, as well as cartilage and connective tissue damage.
- Sjögren's Syndrome: This is a rare autoimmune condition that can cause joint pain and inflammation, as well as dry eyes and mouth.
- Mixed Connective Tissue Disease (MCTD): This is a rare autoimmune condition that can cause joint pain and inflammation, as well as skin, muscle, and lung symptoms.