What is the differential diagnosis for a 44-year-old female presenting with chronic polyarthralgia (multiple joint pains), myalgia (muscle pain), fatigue, episodic neuropathic pain, bilateral foot pain, heel pain, flushing of the upper cheek, neck, and face, and marked erythematous (red) discoloration of the hands and feet?

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Differential Diagnosis for 44 yo Female with Chronic Polyarthralgia, Myalgia, Fatigue, and Other Symptoms

  • Single Most Likely Diagnosis
    • Fibromyalgia: This condition is characterized by chronic widespread musculoskeletal pain, fatigue, sleep, memory, and mood issues, which align with the patient's symptoms of polyarthralgia, myalgia, and fatigue.
  • Other Likely Diagnoses
    • Rheumatoid Arthritis (RA): The patient's symptoms of polyarthralgia, myalgia, and marked erythematous discoloration of hands and feet could be indicative of RA, an autoimmune disorder that causes inflammation in the joints.
    • Lupus: Systemic lupus erythematosus (SLE) is an autoimmune disease that can cause a wide range of symptoms, including joint pain, fatigue, and skin rashes, which are present in this patient.
    • Small Fiber Neuropathy: The episodic neuropathic pain and bilateral foot pain could be related to small fiber neuropathy, a condition characterized by damage to the small nerve fibers in the skin.
  • Do Not Miss Diagnoses
    • Multiple Myeloma: Although less likely, multiple myeloma is a type of blood cancer that can cause bone pain, fatigue, and neuropathic pain, making it a crucial diagnosis not to miss.
    • Sjögren's Syndrome: This autoimmune disorder can cause joint pain, fatigue, and skin rashes, as well as neuropathic pain, and is often associated with other autoimmune diseases like RA and lupus.
    • Vasculitis: Conditions like giant cell arteritis or polyarteritis nodosa can cause a range of symptoms, including joint pain, fatigue, and skin rashes, and can be life-threatening if not promptly diagnosed and treated.
  • Rare Diagnoses
    • Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which could explain the patient's bilateral foot pain and heel pain.
    • Complex Regional Pain Syndrome (CRPS): A rare condition that causes chronic pain, inflammation, and skin changes in one limb, which could be considered given the patient's episodic neuropathic pain and marked erythematous discoloration of hands and feet.

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