Differential Diagnosis for Bilateral Hand Joint Pain
- Single most likely diagnosis
- Osteoarthritis (OA): The patient's symptoms of bilateral hand joint pain, particularly in the distal and proximal interphalangeal joints, are consistent with OA. The absence of systemic symptoms, such as fever or rash, and the lack of family history of autoimmune conditions also support this diagnosis. The patient's occupation as a nocturnal doctor may involve repetitive strain or activities that exacerbate joint pain, which is common in OA.
- Other Likely diagnoses
- Psoriatic arthritis (PsA): Although the patient does not have a family history of autoimmune conditions, PsA can occur without a clear family history. The involvement of multiple joints, including the distal and proximal interphalangeal joints, is consistent with PsA. However, the absence of skin or nail changes and the lack of significant morning stiffness make this diagnosis less likely.
- Gout: Given the patient's father has gout, there is a possible familial component. However, the patient's symptoms do not typically suggest gout, as gout usually presents with acute, severe monoarticular pain and inflammation, often involving the base of the big toe.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic arthritis: Although the patient does not have systemic symptoms, such as fever, or significant joint inflammation, septic arthritis is a medical emergency that requires prompt diagnosis and treatment. The patient's occupation as a doctor may increase the risk of exposure to infectious agents.
- Rheumatoid arthritis (RA): Although the patient does not have a family history of RA, it is essential to consider this diagnosis due to its potential for significant morbidity and mortality. The patient's symptoms do not typically suggest RA, as RA often involves symmetric joint inflammation and morning stiffness.
- Rare diagnoses
- Hemochromatosis: This genetic disorder can cause joint pain and arthritis, particularly in the hands. However, it is a rare condition, and the patient's symptoms do not strongly suggest this diagnosis.
- Sarcoidosis: This condition can cause joint pain and inflammation, but it is relatively rare and often involves other systemic symptoms, such as lung or skin involvement, which are not present in this patient.