Differential Diagnosis
The patient presents with a 2-month history of swelling and tenderness in the joints of her hands, worse in the morning and better in the afternoon, with nodules in the proximal interphalangeal joints and fascial restriction. Based on these symptoms, the differential diagnosis can be categorized as follows:
- Single most likely diagnosis
- E. rheumatoid arthritis: This is the most likely diagnosis due to the symmetric joint involvement, morning stiffness, and presence of nodules on the extensor surfaces of the elbows, which are characteristic of rheumatoid arthritis.
- Other Likely diagnoses
- C. osteoarthritis: Although less likely, osteoarthritis could be considered due to the presence of nodules in the proximal interphalangeal joints, which are commonly affected in osteoarthritis. However, the morning stiffness and symmetric joint involvement are more suggestive of rheumatoid arthritis.
- D. psoriatic arthritis: This diagnosis could be considered if the patient had a history of psoriasis, but it is not mentioned in the scenario. The presence of nodules on the extensor surfaces of the elbows could be consistent with psoriatic arthritis, but the overall clinical picture is more suggestive of rheumatoid arthritis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- B. lupus arthritis: Although less likely, systemic lupus erythematosus (SLE) could present with joint symptoms similar to rheumatoid arthritis. It is essential to consider SLE in the differential diagnosis, as it can have serious consequences if left untreated.
- A. gouty arthritis: Gouty arthritis is typically characterized by acute, intermittent attacks of joint pain and swelling, often accompanied by fever and rash. Although the patient denies fever and rash, it is essential to consider gout in the differential diagnosis, as it can have serious consequences if left untreated.
- Rare diagnoses
- Other rare diagnoses, such as scleroderma or mixed connective tissue disease, could be considered, but they are less likely based on the patient's presentation. These diagnoses would require additional symptoms, such as skin thickening or esophageal dysfunction, to be considered more likely.