Differential Diagnosis for Bilateral Mild Hand Swelling and Joint Pain

Single Most Likely Diagnosis

• Osteoarthritis (OA): This is the most common type of arthritis and can cause bilateral hand swelling and joint pain, especially in older adults. OA often affects the distal interphalangeal joints (DIP) and proximal interphalangeal joints (PIP), leading to symptoms like swelling, pain, and stiffness.

Other Likely Diagnoses

• Rheumatoid Arthritis (RA): An autoimmune disorder that can cause symmetric joint pain and swelling, often affecting the hands. Morning stiffness lasting more than an hour is a hallmark symptom.
• Psoriatic Arthritis (PsA): A condition that combines the swollen, scaly skin of psoriasis with joint pain and arthritis. It can cause swelling in the hands, especially if the patient has a history of psoriasis.
• Gout: Although gout typically affects a single joint at a time, it can cause bilateral hand swelling and pain, especially in chronic cases. Uric acid crystals in the joints lead to sudden, severe attacks of pain, swelling, redness, and tenderness.

Do Not Miss Diagnoses

• Septic Arthritis: A medical emergency where a joint becomes infected, leading to severe pain, swelling, and potential destruction of the joint if not promptly treated. Fever and significant joint effusion are common.
• Lupus: Systemic lupus erythematosus (SLE) is an autoimmune disease that can cause joint pain and swelling, among other systemic symptoms. It's crucial to consider lupus due to its potential for serious complications.
• Sarcoidosis: A condition where inflammatory cells form lumps known as granulomas in various parts of the body, including the joints. It can cause joint pain and swelling, along with other systemic symptoms.

Rare Diagnoses

• Hemochromatosis: A genetic disorder characterized by excessive iron accumulation in the body, leading to various symptoms, including joint pain and swelling, particularly in the second and third metacarpophalangeal joints.
• Sjögren's Syndrome: An autoimmune disorder that primarily affects the glands that produce tears and saliva but can also cause joint pain and swelling.
• Relapsing Polychondritis: A rare autoimmune disorder that causes recurring episodes of cartilage inflammation, leading to joint pain, swelling, and potential destruction of cartilaginous structures.