Differential Diagnosis for Painful/Stiff Joints
The patient presents with a 2-3 month history of painful and stiff joints, particularly in the hips and shoulders, with morning worsening and no fever or rash. Given the patient's outdoor activities and history of tick exposure, Lyme disease is a concern. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Osteoarthritis (OA): The patient's symptoms of joint pain and stiffness, especially in the hips and shoulders, are consistent with OA. Morning stiffness is also a common feature of OA.
- Other Likely diagnoses
- Rheumatoid Arthritis (RA): Although the patient doesn't have fever or rash, RA can present with symmetric joint pain and stiffness, particularly in the mornings.
- Psoriatic Arthritis (PsA): Although no rash is mentioned, PsA can cause joint pain and stiffness, and some patients may not have obvious skin lesions.
- Lyme Arthritis: Given the patient's history of tick exposure and outdoor activities, Lyme arthritis is a possible diagnosis, although it typically presents with a more acute onset and may be accompanied by other symptoms like fever or rash.
- Do Not Miss
- Septic Arthritis: Although the patient doesn't have fever, septic arthritis is a medical emergency that requires prompt diagnosis and treatment. It can present with joint pain and stiffness, and a history of tick exposure increases the risk of bacterial infections.
- Giant Cell Arteritis (GCA): GCA can cause joint pain and stiffness, particularly in the shoulders, and is a medical emergency due to the risk of vision loss.
- Rare diagnoses
- Ankylosing Spondylitis (AS): AS is a chronic inflammatory disease that can cause joint pain and stiffness, particularly in the hips and shoulders. However, it is less common than other diagnoses and typically presents with back pain and stiffness.
- Reactive Arthritis: This condition can cause joint pain and stiffness, particularly after a bacterial infection. Although it is less common, it should be considered in patients with a history of recent infections.
- Hemochromatosis: This genetic disorder can cause joint pain and stiffness, particularly in the hips and shoulders, due to iron accumulation. However, it is a rare condition and would require further testing to diagnose.