Differential Diagnosis for a 29-year-old Female with Bilateral Shoulder and Wrist/Hand Pain

• Single most likely diagnosis:

  • Rheumatoid Arthritis (RA): The patient's symptoms of morning stiffness lasting over an hour, symmetrical joint involvement, swelling and tenderness in wrist and finger joints, and impaired joint movement are classic for RA. The severity of shoulder pain at night and the recent worsening of symptoms also align with RA, which can cause significant nocturnal pain and stiffness.

• Other Likely diagnoses:

  • Psoriatic Arthritis (PsA): Although the patient does not mention skin symptoms, PsA can present with similar joint symptoms to RA, including morning stiffness and symmetrical joint involvement. The absence of skin lesions does not rule out PsA, as some patients may have minimal or no skin involvement.
  • Systemic Lupus Erythematosus (SLE): SLE can cause joint pain and stiffness, particularly in the hands and wrists, and can also cause morning stiffness. However, SLE typically involves other systemic symptoms such as fever, fatigue, and skin rashes, which are not mentioned in the patient's history.
  • Osteoarthritis (OA): Although OA is less common in young adults, it can cause joint pain and stiffness, particularly in the hands and wrists. However, OA typically does not cause significant morning stiffness or symmetrical joint involvement.

• Do Not Miss diagnoses:

  • Septic Arthritis: Although the patient's symptoms have been present for several months, septic arthritis can cause severe joint pain and stiffness, particularly if the infection is chronic. It is essential to consider septic arthritis, especially if the patient has a history of intravenous drug use or other risk factors for infection.
  • Lyme Arthritis: Lyme disease can cause arthritis, particularly in the knees, but can also affect other joints. The patient's symptoms of joint pain and stiffness, particularly if she has a history of tick exposure, should prompt consideration of Lyme arthritis.
  • Gout: Gout can cause severe joint pain and stiffness, particularly in the hands and wrists. Although gout is less common in young women, it is essential to consider gout, especially if the patient has a history of kidney stones or other risk factors.

• Rare diagnoses:

  • Relapsing Polychondritis: This rare autoimmune disorder can cause joint pain and stiffness, particularly in the hands and wrists, as well as inflammation of cartilaginous structures such as the ears and nose.
  • Sjögren's Syndrome: This autoimmune disorder can cause joint pain and stiffness, particularly in the hands and wrists, as well as dry eyes and mouth.
  • Mixed Connective Tissue Disease (MCTD): MCTD is a rare autoimmune disorder that can cause joint pain and stiffness, particularly in the hands and wrists, as well as other systemic symptoms such as fever and fatigue.