Differential Diagnosis for 95 yo with CMC Inflammation, Proteinuria, Dysphagia

• Single Most Likely Diagnosis
  • Giant Cell Arteritis (GCA) with Polymyalgia Rheumatica (PMR): This diagnosis is likely due to the combination of CMC (crystalline macular degeneration is not applicable here, likely referring to carpometacarpal joint) inflammation, which could be indicative of an inflammatory arthritis, and the age of the patient. GCA and PMR are more common in older adults and can present with systemic symptoms including inflammation in various joints.
• Other Likely Diagnoses
  • Rheumatoid Arthritis (RA): Although less common in new onset at 95 years old, RA can cause joint inflammation and is associated with various systemic symptoms, including potentially dysphagia if there is significant cervical spine involvement or if there are associated rheumatoid nodules in the esophagus.
  • Sjögren's Syndrome: This autoimmune disorder can cause joint pain and inflammation, and is also associated with renal involvement (potentially causing proteinuria) and esophageal dysmotility leading to dysphagia.
  • Mixed Connective Tissue Disease (MCTD): This disease combines features of lupus, scleroderma, and rheumatoid arthritis, and could explain the combination of joint inflammation, proteinuria (from renal involvement), and dysphagia (from esophageal involvement).
• Do Not Miss Diagnoses
  • Amyloidosis: This condition can cause proteinuria due to renal involvement and can also lead to dysphagia if there is esophageal involvement. It's less common but can be deadly if missed due to its potential for multi-organ failure.
  • Scleroderma (Systemic Sclerosis): This disease can cause skin thickening, esophageal dysmotility leading to dysphagia, and renal crisis, which would explain the proteinuria. It's crucial not to miss this diagnosis due to its potential for severe organ damage.
  • Vasculitis (e.g., ANCA-associated vasculitis): These conditions can cause a wide range of symptoms including renal issues (proteinuria), joint inflammation, and potentially dysphagia if there is esophageal involvement. Missing this diagnosis could lead to severe consequences, including organ failure.
• Rare Diagnoses
  • Relapsing Polychondritis: This rare autoimmune disorder can cause inflammation of cartilaginous structures, potentially explaining the CMC inflammation, and can also involve other systems, leading to a wide range of symptoms including dysphagia and potentially proteinuria if there is renal involvement.
  • Eosinophilic Esophagitis with Systemic Involvement: While primarily causing dysphagia, in rare cases, it could be part of a systemic condition that also involves joint inflammation and renal issues, though this would be highly unusual.