Differential Diagnosis
- Single most likely diagnosis
- Polymyalgia Rheumatica (PMR): This diagnosis is the most likely due to the patient's age, symptoms of bilateral shoulder and hip girdle discomfort, mild weight loss, low-grade fever, and significantly elevated ESR. The presence of severe pain and stiffness, particularly in the morning, and significant pain when trying to rise from a chair, are also characteristic of PMR.
- Other Likely diagnoses
- Rheumatoid Arthritis (RA): Although the patient's symptoms are more suggestive of PMR, RA could be considered, especially given the presence of joint pain and stiffness. However, the lack of motor weakness, normal sensation, and absence of significant joint swelling or deformity make this diagnosis less likely.
- Osteoarthritis (OA): The patient's X-rays show degenerative changes, which could suggest OA. However, the patient's symptoms of systemic inflammation (e.g., low-grade fever, elevated ESR) and significant pain with movement are not typical of OA.
- Do Not Miss
- Giant Cell Arteritis (GCA): This diagnosis is a "do not miss" because it can lead to serious complications, such as visual loss, if left untreated. Although the patient's symptoms do not specifically suggest GCA, the elevated ESR and age of the patient make it a consideration.
- Malignancy (e.g., multiple myeloma, lymphoma): Although less likely, malignancy could present with similar symptoms, such as weight loss, fatigue, and elevated ESR. It is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Infection (e.g., endocarditis, osteomyelitis): Infection could also present with similar symptoms, such as low-grade fever and elevated ESR. Although less likely, it is crucial to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Rare diagnoses
- Relapsing Polychondritis: This rare autoimmune disorder could present with similar symptoms, such as joint pain and stiffness. However, it is much less common than PMR and would require additional diagnostic testing to confirm.
- Sarcoidosis: This rare condition could present with similar symptoms, such as joint pain and stiffness, as well as systemic inflammation. However, it is much less common than PMR and would require additional diagnostic testing to confirm.