Differential Diagnosis for Bilateral Wrist Pain

Single Most Likely Diagnosis

• Rheumatoid Arthritis (RA): This is a common cause of bilateral wrist pain, especially with morning stiffness, pain at night, and worsening with movement. The constant pain rated 8/10 for approximately 6 weeks aligns with the chronic nature of RA.

Other Likely Diagnoses

• Osteoarthritis (OA): Although OA is more commonly associated with asymmetric joint involvement, it can cause bilateral wrist pain, especially in older adults. The pain pattern described could fit OA, particularly if there's a history of trauma or repetitive strain.
• Tendinitis or Tenosynovitis: Inflammation of the tendons or their synovial sheaths around the wrist can cause pain that worsens with movement. This condition is common in individuals who perform repetitive wrist motions.
• Carpal Tunnel Syndrome: This condition can cause wrist pain, especially at night, due to median nerve compression. However, it typically presents with additional symptoms like numbness, tingling, and weakness in the hand.

Do Not Miss Diagnoses

• Septic Arthritis: Although less likely, septic arthritis is a medical emergency that requires prompt diagnosis and treatment. It can present with severe, constant pain, swelling, and decreased range of motion, especially if there's a history of recent infection or immune compromise.
• Gout or Pseudogout: These crystalline arthropathies can cause sudden, severe joint pain and should be considered, especially if there are risk factors like hyperuricemia or a history of similar episodes.
• Lyme Arthritis: In endemic areas, Lyme disease can cause arthritis that might present with bilateral wrist pain among other symptoms. It's crucial to consider this diagnosis to initiate appropriate antibiotic treatment.

Rare Diagnoses

• Hemochromatosis: This genetic disorder leads to iron overload and can cause arthropathy, including wrist pain, though it's much less common.
• Sarcoidosis: A systemic disease that can cause arthritis, including wrist involvement, though it's rare and usually accompanied by other systemic symptoms.
• Amyloidosis: A condition characterized by the deposition of amyloid proteins in various tissues, including joints, leading to pain and stiffness, though it's exceedingly rare and typically presents with other systemic manifestations.