Differential Diagnosis for Dip Lumps in Both Hands of a 70-Year-Old Female
Single Most Likely Diagnosis
- Rheumatoid Arthritis (RA): This is a common condition in elderly females, characterized by symmetric joint involvement, including the hands. The presence of lumps (possibly rheumatoid nodules) and symmetric hand involvement makes RA a strong consideration.
Other Likely Diagnoses
- Osteoarthritis (OA): While OA is very common in the elderly, it typically affects the distal interphalangeal joints (DIP) and proximal interphalangeal joints (PIP) asymmetrically. However, it could be considered, especially if the "lumps" are actually Heberden's or Bouchard's nodes.
- Gout: Gouty tophi can present as lumps in the hands, especially in elderly females. The diagnosis would be supported by a history of gouty attacks, elevated uric acid levels, or identification of urate crystals in the tophi.
- Psoriatic Arthritis: This condition can cause swelling and lumps in the hands, along with skin and nail changes typical of psoriasis.
Do Not Miss Diagnoses
- Giant Cell Arteritis: Although this condition primarily affects the temporal arteries, it can also involve other arteries, including those in the hands, leading to ischemic symptoms or lumps due to arteritis.
- Sarcoidosis: This systemic disease can cause granulomatous inflammation in various parts of the body, including the hands, leading to lumps or nodules.
- Infection (e.g., Mycobacterial or Fungal): Chronic infections can cause lumps or nodules in the hands, especially in immunocompromised individuals.
Rare Diagnoses
- Relapsing Polychondritis: A rare autoimmune disorder that can cause cartilaginous structures to become inflamed, potentially leading to lumps or deformities in the hands.
- Multicentric Reticulohistiocytosis: A rare condition characterized by the development of skin and mucous membrane lesions, including lumps in the hands, due to the proliferation of histiocytes.
- Sjögren's Syndrome: An autoimmune disorder that primarily affects the exocrine glands, but can also cause systemic symptoms, including joint pain and swelling that might be mistaken for lumps in the hands.