Differential Diagnosis for Pain in Shoulder Blade and Hip with Low-Grade Fever, High CRP, and ESR
Single Most Likely Diagnosis
- Polymyalgia Rheumatica (PMR): This condition is characterized by aching and stiffness in the shoulder and hip areas, often accompanied by elevated inflammatory markers like CRP and ESR. The presence of low-grade fever also supports this diagnosis, as it is a common symptom in PMR.
Other Likely Diagnoses
- Rheumatoid Arthritis (RA): Although RA typically presents with more symmetric joint involvement, it can sometimes start with shoulder and hip pain. The high CRP and ESR levels are consistent with an active inflammatory process like RA.
- Osteoarthritis with Inflammatory Component: While osteoarthritis is generally considered a wear-and-tear disease, some patients can have an inflammatory component that elevates CRP and ESR. The pain in the shoulder blade and hip could be related to osteoarthritis, especially if there's a history of trauma or overuse.
- Fibromyalgia: This condition is characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. However, fibromyalgia typically does not cause significant elevations in CRP and ESR, making it less likely given the lab results.
Do Not Miss Diagnoses
- Multiple Myeloma: A type of blood cancer that can cause bone pain, including pain in the shoulder blades and hips, along with elevated CRP and ESR due to the inflammatory nature of the disease. It's crucial to consider this diagnosis due to its severe implications if missed.
- Infectious Endocarditis: Although less common, infectious endocarditis can present with systemic symptoms like low-grade fever and elevated inflammatory markers. It's a life-threatening condition that requires prompt diagnosis and treatment.
- Lymphoma: Certain types of lymphoma can cause systemic symptoms, including fever and elevated CRP and ESR. Bone pain can also be a presenting symptom, especially if the lymphoma involves the bone marrow.
Rare Diagnoses
- Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation in various parts of the body, including the cartilage. It might present with pain in the shoulder and hip areas, along with systemic symptoms like fever.
- Sarcoidosis: A condition characterized by the growth of granulomas (inflammatory cells) in various parts of the body. It can cause a wide range of symptoms, including joint pain and elevated inflammatory markers, although it's less commonly associated with the specific pattern of pain described.