Differential Diagnosis for Heaviness in Head, Rare Left Side Lateral Chest Pain, and History of RA

• Single Most Likely Diagnosis
  • Rheumatoid Arthritis (RA) flare or associated condition: Given the patient's history of RA, it's plausible that the symptoms are related to an RA flare or a condition associated with RA, such as rheumatoid nodules or pleuritis, which could cause chest pain and possibly contribute to the sensation of heaviness in the head due to systemic inflammation.
• Other Likely Diagnoses
  • Fibromyalgia: This condition often co-exists with RA and can cause widespread pain, including chest pain and headaches, which might be perceived as heaviness in the head.
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone, which can cause chest pain and might be related to RA or occur independently.
  • Temporomandibular Joint (TMJ) Disorder: Could cause referred pain leading to a sensation of heaviness in the head and might also contribute to or exacerbate chest pain if the patient has a habit of clenching or grinding their teeth in response to pain or stress.
• Do Not Miss Diagnoses
  • Myocardial Infarction (MI): Although less common on the left side, chest pain can be a symptom of an MI, and it's crucial to rule out cardiac causes, especially in patients with a history of autoimmune diseases like RA, which can increase cardiovascular risk.
  • Pulmonary Embolism (PE): Can cause sudden onset of chest pain and might be associated with a feeling of heaviness or pressure in the chest that could be misinterpreted as head heaviness.
  • Giant Cell Arteritis (GCA): Given the patient's history of RA, there's an increased risk of developing other autoimmune conditions like GCA, which can cause headaches and, less commonly, chest pain.
• Rare Diagnoses
  • Sjögren's Syndrome: An autoimmune disorder that can cause a variety of symptoms, including joint pain, dry eyes, and potentially chest pain or neurological symptoms that might be perceived as heaviness in the head.
  • Mixed Connective Tissue Disease (MCTD): A condition that combines features of RA, lupus, scleroderma, and polymyositis, which could potentially explain the diverse symptoms presented.
  • Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation in various cartilaginous structures, potentially leading to chest pain and other systemic symptoms.