Differential Diagnosis for Nausea in a 41-year-old Female with Ankylosing Spondylitis
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is common in the general population and can be exacerbated by certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), which are often used to treat ankylosing spondylitis. Chronic nausea is a frequent symptom of GERD.
Other Likely Diagnoses
- Irritable Bowel Syndrome (IBS): IBS can cause chronic nausea, among other gastrointestinal symptoms, and is common in patients with chronic inflammatory diseases like ankylosing spondylitis.
- Medication Side Effects: Many medications used to treat ankylosing spondylitis, such as NSAIDs, disease-modifying antirheumatic drugs (DMARDs), and biologics, can cause nausea as a side effect.
- Anxiety or Depression: These conditions are common comorbidities in patients with chronic diseases like ankylosing spondylitis and can cause or exacerbate nausea.
Do Not Miss Diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic nausea and are associated with ankylosing spondylitis. Missing this diagnosis could lead to delayed treatment and significant morbidity.
- Gastric Cancer: Although rare, gastric cancer can present with chronic nausea and is more common in patients with certain chronic inflammatory conditions. Early detection is crucial for treatment.
- Adrenal Insufficiency: This condition can occur in patients taking long-term corticosteroids for ankylosing spondylitis and can cause nausea, among other symptoms. It is a medical emergency if not recognized and treated promptly.
Rare Diagnoses
- Celiac Disease: An autoimmune disorder that can cause chronic nausea and is associated with certain rheumatic diseases, including ankylosing spondylitis.
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, which can cause chronic nausea and is more common in patients with atopic diseases or other autoimmune conditions.
- Gastroparesis: A condition characterized by delayed gastric emptying, which can cause chronic nausea and is associated with certain autoimmune and rheumatic diseases.