Differential Diagnosis for Heightened Left Hand Numbness in a Patient with Lupus and Psoriatic Arthritis
- Single Most Likely Diagnosis
- Carpal Tunnel Syndrome: This condition is a common cause of hand numbness, especially in patients with autoimmune diseases like lupus and psoriatic arthritis, which can increase the risk of developing carpal tunnel syndrome due to inflammation and swelling in the wrist.
- Other Likely Diagnoses
- Ulnar Nerve Entrapment: This condition can cause numbness in the hand, particularly in the little and ring fingers, and is more likely in patients with conditions that cause nerve damage or inflammation, such as lupus and psoriatic arthritis.
- Radial Nerve Compression: Although less common, compression of the radial nerve can cause numbness and weakness in the back of the hand and is a possibility in patients with conditions that affect multiple joints and nerves.
- Cervical Radiculopathy: Given the patient's history of psoriatic arthritis, which can affect the spine, cervical radiculopathy (nerve root compression in the neck) is a plausible cause of hand numbness, especially if the arthritis has led to spinal degeneration or inflammation.
- Do Not Miss Diagnoses
- Multiple Sclerosis: Although less likely, multiple sclerosis (MS) can present with numbness in one hand and is a critical diagnosis not to miss due to its significant impact on the patient's quality of life and the availability of disease-modifying treatments. MS can be considered, especially if there are other neurological symptoms.
- Stroke or Transient Ischemic Attack (TIA): Acute onset of numbness in one hand could be a sign of a stroke or TIA, which are medical emergencies requiring immediate attention. The patient's history of lupus increases the risk of stroke due to associated antiphospholipid syndrome or other cardiovascular risks.
- Rare Diagnoses
- Syringomyelia: A rare condition characterized by the development of a fluid-filled cavity within the spinal cord, which can cause numbness and weakness in the hands. It's less likely but should be considered if other diagnoses are ruled out and the patient has progressive neurological symptoms.
- Vitamin B12 Deficiency: Can cause neurological symptoms including numbness in the hands, though it's less directly related to the patient's primary conditions of lupus and psoriatic arthritis unless they have a specific dietary restriction or malabsorption issue.