Differential Diagnosis for Polyarthralgia of Wrists and Hands

Single Most Likely Diagnosis

• Rheumatoid Arthritis (RA): This is a common autoimmune disorder that often presents with symmetric polyarthralgia, particularly affecting the wrists and hands. Morning stiffness lasting more than an hour and systemic symptoms like fatigue can accompany the joint pain.

Other Likely Diagnoses

• Osteoarthritis (OA): Although OA more commonly affects weight-bearing joints and the distal interphalangeal joints, it can also involve the wrists and hands, especially in older adults or those with a history of trauma or repetitive strain.
• Psoriatic Arthritis (PsA): This condition often presents with asymmetric joint involvement but can also cause symmetric polyarthralgia. The presence of psoriatic skin lesions or nail changes can help in diagnosing PsA.
• Systemic Lupus Erythematosus (SLE): SLE is an autoimmune disease that can cause polyarthralgia, among other systemic symptoms such as skin rashes, kidney disease, and neurological manifestations.

Do Not Miss Diagnoses

• Septic Arthritis: Although less common, septic arthritis is a medical emergency that requires prompt diagnosis and treatment. It typically presents with acute, severe monoarthritis but can occasionally involve multiple joints.
• Gout or Pseudogout: These are forms of crystal-induced arthritis that can cause acute, severe joint pain. While they often affect a single joint, they can occasionally present with polyarticular involvement.
• Lyme Disease: Caused by the bacterium Borrelia burgdorferi, Lyme disease can lead to Lyme arthritis, which may present as polyarthralgia, particularly if the disease is in its later stages.

Rare Diagnoses

• Relapsing Polychondritis: A rare autoimmune disorder characterized by recurrent episodes of cartilaginous inflammation, which can lead to polyarthralgia among other symptoms.
• Sjögren's Syndrome: An autoimmune disorder that primarily affects the exocrine glands, leading to dry eyes and mouth, but can also cause polyarthralgia and arthritis.
• Hemochromatosis: A genetic disorder leading to iron overload, which can cause arthropathy, particularly affecting the second and third metacarpophalangeal joints, resembling OA but with a distinct pattern.
• Sarcoidosis: A condition characterized by the formation of granulomas in various parts of the body, which can lead to polyarthralgia among other systemic symptoms.