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Differential Diagnosis for a 72-year-old with Pain and Stiffness in the Shoulder and Pelvic Girdle Areas

Single Most Likely Diagnosis

  • Polymyalgia Rheumatica (PMR): This condition is characterized by pain and stiffness in the shoulder and pelvic girdle areas, often accompanied by fever, fatigue, and morning stiffness. The patient's age and symptom distribution are consistent with PMR, making it the most likely diagnosis.

Other Likely Diagnoses

  • Giant Cell Arteritis: Although it primarily affects the head, Giant Cell Arteritis can sometimes present with systemic symptoms similar to PMR, including fever and fatigue. It's a related condition that often co-exists with PMR.
  • Rheumatoid Arthritis: While less common in this age group without prior history, Rheumatoid Arthritis can present with symmetric polyarthritis, including shoulder and pelvic girdle involvement, along with systemic symptoms like fever and fatigue.
  • Osteoarthritis with Inflammatory Component: In some cases, osteoarthritis can have an inflammatory component that might mimic the symptoms described, especially if there's significant joint involvement in the shoulders and pelvis.

Do Not Miss Diagnoses

  • Septic Arthritis or Osteomyelitis: Infections in the joints or bones can present with pain, stiffness, fever, and fatigue. These conditions are medical emergencies requiring prompt diagnosis and treatment to prevent serious complications.
  • Multiple Myeloma: A malignancy of plasma cells that can cause bone pain, fatigue, and fever. Although less likely, it's crucial to consider due to its severe implications and the need for early intervention.
  • Metastatic Cancer: Cancers that metastasize to the bones, such as prostate, breast, or lung cancer, can cause pain and stiffness in the affected areas, along with systemic symptoms like fever and fatigue.

Rare Diagnoses

  • Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation in various cartilaginous structures, including joints, leading to pain and stiffness, but it's less likely given the specific distribution of symptoms.
  • Sarcoidosis: A condition characterized by the growth of granulomas in various parts of the body, which can occasionally present with musculoskeletal symptoms, but it's less common and would typically include other systemic or pulmonary findings.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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