Differential Diagnosis for Erosive Arthritic Changes with Synovitis Involving Small Joints of Hand
- Single Most Likely Diagnosis
- Rheumatoid Arthritis (RA): This is the most common cause of erosive arthritic changes with synovitis involving the small joints of the hand. RA is a chronic autoimmune disorder characterized by symmetric polyarthritis, often affecting the hands and feet, and can lead to significant joint damage and disability if not treated promptly.
- Other Likely Diagnoses
- Psoriatic Arthritis (PsA): This condition is characterized by psoriasis combined with joint inflammation, which can lead to erosive changes, especially in the hands. The presence of psoriatic skin lesions or nail changes can help differentiate PsA from RA.
- Osteoarthritis (OA) with Erosive Changes: While OA is more commonly associated with non-erosive joint changes, an erosive subtype can occur, particularly in the hands. However, the pattern of joint involvement and the presence of synovitis might be less typical for OA compared to RA or PsA.
- Do Not Miss Diagnoses
- Septic Arthritis: Although less common, septic arthritis is a medical emergency that requires immediate attention. It can present with sudden onset of joint pain, swelling, and fever, and can lead to rapid joint destruction if not promptly treated with antibiotics.
- Lyme Arthritis: Caused by the bacterium Borrelia burgdorferi, Lyme disease can lead to arthritis, particularly in the knees, but can also affect smaller joints. It's crucial to consider this diagnosis, especially in endemic areas, as it requires specific antibiotic treatment.
- Crystal Arthropathies (Gout or Pseudogout): These conditions can cause sudden, severe joint pain and swelling, often accompanied by synovitis. While they more commonly affect larger joints, they can involve smaller joints and must be considered to provide appropriate treatment.
- Rare Diagnoses
- Sjögren's Syndrome: An autoimmune disorder that primarily affects the glands that produce tears and saliva, but can also cause arthritis. The arthritic component can mimic RA, making it a rare but important consideration in the differential diagnosis.
- Systemic Lupus Erythematosus (SLE): A chronic autoimmune disease that can affect various parts of the body, including the joints. While joint involvement in SLE can be similar to RA, the presence of other systemic symptoms or specific autoantibodies can help differentiate SLE.
- Hemochromatosis: A genetic disorder characterized by excessive iron accumulation in the body, which can lead to arthropathy, among other symptoms. The arthropathy can mimic OA but has distinctive features, such as involvement of the second and third metacarpophalangeal joints.