Differential Diagnosis for Acute Knuckle Swelling in a Celiac Patient
Single Most Likely Diagnosis
- Celiac Arthropathy: This condition is a common extraintestinal manifestation of celiac disease, characterized by joint pain and swelling, which can occur acutely. The patient's celiac disease status increases the likelihood of this diagnosis.
Other Likely Diagnoses
- Gout: Although less common in the fingers, gout can cause acute joint swelling and is a consideration in any patient with acute monoarthritis. The patient's celiac disease may increase the risk of gout due to malabsorption of nutrients.
- Pseudogout (Calcium Pyrophosphate Deposition Disease, CPPD): Similar to gout, pseudogout can cause acute joint swelling and may be considered, especially if there's a history of joint disease or if the patient has other metabolic disorders.
- Septic Arthritis: Although less likely without a clear history of trauma or infection, septic arthritis is a consideration in any acute monoarthritis due to its potential for severe joint damage if not promptly treated.
Do Not Miss Diagnoses
- Osteonecrosis: While rare, osteonecrosis (especially of the metacarpal heads) could present with acute swelling and pain. Missing this diagnosis could lead to significant morbidity.
- Infectious Arthritis (e.g., Lyme Arthritis): In endemic areas, Lyme disease can cause arthritis that might present with acute knuckle swelling. Given the potential for serious consequences if untreated, it's crucial not to miss this diagnosis.
Rare Diagnoses
- Hemochromatosis: A genetic disorder leading to iron overload, which can cause arthropathy similar to osteoarthritis but might present with acute episodes of joint swelling.
- Sarcoid Arthritis: Sarcoidosis can cause arthritis, which might present as acute swelling in one or more joints, including the knuckles.
- Amyloidosis: In rare cases, amyloid deposits can cause joint swelling and pain, although this would typically be part of a systemic disease presentation.