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Differential Diagnosis

The patient presents with significant weight loss, SSA IgG positivity, negative rheumatoid factor, and bilateral lower extremity pain. Here's a categorized differential diagnosis:

  • Single most likely diagnosis
    • Sjögren's syndrome: This autoimmune disorder is characterized by the presence of SSA IgG antibodies and can cause systemic symptoms such as weight loss and musculoskeletal pain, including lower extremity pain.
  • Other Likely diagnoses
    • Systemic Lupus Erythematosus (SLE): Although the patient is rheumatoid factor negative, SLE can still be considered, especially with the presence of SSA IgG antibodies and systemic symptoms like weight loss and lower extremity pain.
    • Mixed Connective Tissue Disease (MCTD): This condition overlaps with various autoimmune diseases, including SLE and Sjögren's syndrome, and can present with similar symptoms.
    • Rheumatoid Arthritis (RA): Despite the negative rheumatoid factor, RA can still occur, especially if the patient has other symptoms like morning stiffness or joint swelling.
  • Do Not Miss diagnoses
    • Osteomyelitis or septic arthritis: These conditions can cause severe lower extremity pain and should be considered, especially if there's a history of trauma, injection drug use, or immunocompromised state.
    • Lymphoma: Certain types of lymphoma, such as non-Hodgkin lymphoma, can cause systemic symptoms like weight loss and musculoskeletal pain.
    • Vasculitis: Conditions like giant cell arteritis or polyarteritis nodosa can cause lower extremity pain and should be considered, especially if there are other symptoms like fever, fatigue, or neurological deficits.
  • Rare diagnoses
    • Relapsing polychondritis: This rare autoimmune disorder can cause musculoskeletal pain, including lower extremity pain, and should be considered if other symptoms like cartilage or ear involvement are present.
    • Eosinophilia-myalgia syndrome: This rare condition can cause severe musculoskeletal pain, including lower extremity pain, and should be considered if there's a history of eosinophilia or recent medication changes.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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