Differential Diagnosis for Nocturnal Joint Pain

• Single most likely diagnosis
  • Osteoarthritis: This is the most common cause of nocturnal joint pain, especially in older adults. The pain is often worse at night due to increased pressure on the joints and decreased movement, which can lead to stiffness.
• Other Likely diagnoses
  • Rheumatoid Arthritis: This autoimmune disorder can cause joint pain that worsens at night, often accompanied by morning stiffness.
  • Gout: Although gout typically presents with acute, severe pain, some patients may experience chronic nocturnal pain, especially if the condition is not well-managed.
  • Fibromyalgia: Characterized by widespread musculoskeletal pain, fibromyalgia can cause nocturnal pain due to poor sleep quality and increased sensitivity to pain.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Bone Cancer (e.g., osteosarcoma): Although rare, bone cancer can cause nocturnal pain due to the tumor's growth and pressure on surrounding tissues.
  • Osteonecrosis: This condition, also known as avascular necrosis, can cause severe nocturnal pain due to the death of bone tissue.
  • Infection (e.g., septic arthritis): Bacterial or fungal infections can cause severe joint pain, which may worsen at night.
• Rare diagnoses
  • Charcot Joint (Neuropathic Arthropathy): This condition, often associated with diabetes or other neuropathic disorders, can cause nocturnal joint pain due to nerve damage and joint degeneration.
  • Hemochromatosis: This genetic disorder can lead to iron overload, causing joint pain, including nocturnal pain, due to iron deposition in the joints.
  • Sickle Cell Disease: Patients with sickle cell disease may experience nocturnal joint pain due to vaso-occlusive crises, which can cause bone and joint pain.