Differential Diagnosis

The patient presents with fibromyalgia, thoracic outlet syndrome, finger swellings, and mildly raised ear and CRP levels. Here's a breakdown of potential diagnoses:

• Single Most Likely Diagnosis

  • Rheumatoid Arthritis (RA): The presence of finger swellings and mildly raised CRP levels could suggest an inflammatory arthritis like RA, especially if the patient's fibromyalgia symptoms are overlapping or if there's an underlying inflammatory process not fully captured by the fibromyalgia diagnosis alone.

• Other Likely Diagnoses

  • Psoriatic Arthritis: Given the finger swellings and the possibility of an inflammatory component, psoriatic arthritis should be considered, especially if there's a history of psoriasis or if the patient has nail changes or skin lesions suggestive of psoriasis.
  • Osteoarthritis with Inflammatory Component: While osteoarthritis is typically non-inflammatory, some patients can have an inflammatory component that might explain the mildly raised CRP and finger swellings.
  • Thoracic Outlet Syndrome Complications: The patient's known thoracic outlet syndrome could potentially lead to complications such as nerve damage or vascular issues that might cause swelling or other symptoms in the fingers.

• Do Not Miss Diagnoses

  • Giant Cell Arteritis: Although less common, giant cell arteritis (GCA) can present with elevated CRP and could potentially cause swelling or other symptoms in the fingers, especially if there's involvement of the upper limb arteries. Missing GCA could lead to serious complications like vision loss.
  • Polymyalgia Rheumatica: Similar to GCA, polymyalgia rheumatica can cause elevated inflammatory markers and might present with symptoms that overlap with fibromyalgia, making it a "do not miss" diagnosis due to its potential for serious complications if untreated.
  • Lymphoma or Other Malignancies: While rare, certain malignancies can cause systemic inflammation, elevated CRP, and a variety of other symptoms that might mimic or complicate fibromyalgia and thoracic outlet syndrome.

• Rare Diagnoses

  • Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation in various cartilaginous structures, potentially leading to swelling and other symptoms.
  • Sarcoidosis: A condition that can cause inflammation in various parts of the body, potentially leading to symptoms that might overlap with the patient's presentation, including elevated CRP and swelling.
  • Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues, potentially leading to a variety of symptoms including joint hypermobility and tissue fragility.