Differential Diagnosis for Migratory Joint Pain
Single Most Likely Diagnosis
- Rheumatoid Arthritis (RA): This is a common autoimmune disorder characterized by symmetric, additive, and migratory polyarthritis, making it a leading consideration for migratory joint pain. The presence of morning stiffness, swelling, and systemic symptoms like fatigue further supports this diagnosis.
Other Likely Diagnoses
- Lyme Disease: Caused by the bacterium Borrelia burgdorferi, Lyme disease can present with migratory arthritis, particularly affecting the large joints. A history of tick exposure and the presence of erythema migrans rash are key diagnostic clues.
- Gonococcal Arthritis: This condition, resulting from Neisseria gonorrhoeae infection, can cause migratory polyarthritis, especially in sexually active young adults. The presence of skin lesions, urethritis, or cervicitis may accompany the joint symptoms.
- Reactive Arthritis: Previously known as Reiter's syndrome, this form of arthritis occurs as a reaction to an infection elsewhere in the body, often in the gastrointestinal tract or the urethra. It is characterized by the classic triad of arthritis, urethritis, and conjunctivitis.
Do Not Miss Diagnoses
- Septic Arthritis: Although less common, septic arthritis is a medical emergency that requires prompt diagnosis and treatment to prevent joint destruction and systemic complications. The presence of a single, severely affected joint with significant pain, swelling, and decreased range of motion, especially in the context of fever or immunocompromised state, should raise suspicion.
- Crystal Arthropathies (Gout or Pseudogout): While these conditions typically present with monoarthritis, they can occasionally cause migratory symptoms. Gout, caused by monosodium urate crystals, and pseudogout, caused by calcium pyrophosphate dihydrate crystals, can lead to severe joint damage if not properly managed.
- Endocarditis: Infective endocarditis, an infection of the heart valves, can present with systemic symptoms including migratory arthralgias. The presence of fever, heart murmur, and embolic phenomena should prompt consideration of this diagnosis.
Rare Diagnoses
- Relapsing Polychondritis: A rare autoimmune disorder characterized by recurrent episodes of cartilaginous inflammation, which can affect the joints among other structures like the ears, nose, and trachea.
- Whipple's Disease: A systemic bacterial infection caused by Tropheryma whipplei, which can present with migratory arthralgias along with gastrointestinal symptoms, weight loss, and neurological manifestations.
- Sarcoidosis: An autoimmune disease that can affect multiple organs, including the joints, causing migratory arthralgias or arthritis, often accompanied by pulmonary symptoms, skin lesions, or eye involvement.