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Differential Diagnosis for 72-year-old Male with Prostate Cancer and Finger Pain

Single Most Likely Diagnosis

  • Gout: Given the patient's age, use of prednisone (which can increase uric acid levels), and the acute onset of joint pain without trauma, gout is a strong consideration. The involvement of a single joint (monoarthritis), particularly the 4th finger, and pain at the MCP joint, are consistent with gouty arthritis.

Other Likely Diagnoses

  • Osteoarthritis: Although the X-ray is normal, osteoarthritis (OA) can cause pain and decreased range of motion, especially in the fingers. The lack of flexion at the PIP joint could be due to OA, but the acute presentation and lack of previous symptoms make it less likely.
  • Seronegative Arthritis: Conditions like psoriatic arthritis or rheumatoid arthritis (though less common in this age group without previous symptoms) could present with joint pain and decreased mobility. However, the absence of systemic symptoms or skin findings makes this less likely.
  • Tendinitis or Tenosynovitis: Inflammation of the tendons or tendon sheaths around the affected finger could cause pain and limited mobility, especially with the use of medications that might affect tendon health.

Do Not Miss Diagnoses

  • Septic Arthritis: Although less likely without systemic signs of infection or a clear source of infection, septic arthritis is a medical emergency that requires prompt diagnosis and treatment. The patient's age and immunosuppressed state due to cancer and its treatment increase the risk.
  • Neoplastic Involvement: Direct spread of prostate cancer to the bone or a paraneoplastic syndrome could, though rarely, cause localized bone or joint pain. Given the patient's known cancer, this must be considered.

Rare Diagnoses

  • Amyloidosis: Associated with chronic diseases, including some cancers, amyloidosis can cause joint pain and stiffness, but it is rare and would typically present with more systemic symptoms.
  • Hematoma or Vascular Event: A spontaneous hematoma or a vascular event like a digital artery occlusion could cause acute finger pain but would likely have other associated signs or symptoms.
  • Complex Regional Pain Syndrome (CRPS): This condition can follow minor trauma (which the patient denies) and causes significant pain and mobility issues in the affected limb, but it's less common in this demographic without a clear precipitant.

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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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