Differential Diagnosis
- Single most likely diagnosis
- Rheumatoid Arthritis (RA): The presence of bilateral symmetric synovitis of the MCP joints, erosions, and narrowing of the joint spaces on X-ray are highly suggestive of RA. Although the anti-CCP is negative, it is not uncommon for patients with early RA to be seronegative.
- Other Likely diagnoses
- Psoriatic Arthritis (PsA): The presence of erosions and joint space narrowing could also be seen in PsA, although the lack of other symptoms such as skin or nail changes makes this less likely.
- Gout: The elevated uric acid level could suggest gout, but the bilateral symmetric nature of the synovitis and the X-ray findings are not typical of gout.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic Arthritis: Although the patient does not have other systemic symptoms, septic arthritis can present with joint pain and swelling, and can be devastating if not promptly treated.
- Lyme Arthritis: If the patient has been exposed to ticks, Lyme arthritis could be a consideration, although the bilateral symmetric nature of the synovitis is not typical.
- Rare diagnoses
- Hemochromatosis: This condition can cause arthropathy, but it is rare and would typically be associated with other systemic symptoms.
- Wilson's Disease: This condition can cause arthritis, but it is rare and would typically be associated with other systemic symptoms such as liver disease or neurological symptoms.