Differential Diagnosis for Patient with Hip Pain, Stiffness, Shoulder Pain, and Peeling of Epidermis
- Single Most Likely Diagnosis
- Polymyalgia Rheumatica (PMR) with possible associated Giant Cell Arteritis (GCA) and a skin condition: The initial presentation of hip pain, stiffness, and shoulder pain, along with elevated ESR and CRP, strongly suggests PMR. The subsequent development of peeling of the epidermis on hands could be related to a skin condition that sometimes accompanies PMR or GCA, such as a form of vasculitis or a reaction to medication.
- Other Likely Diagnoses
- Rheumatoid Arthritis (RA): Although less likely given the age and initial presentation, RA can cause similar symptoms and should be considered, especially if there are signs of joint inflammation or if the patient does not respond to PMR treatment.
- Psoriatic Arthritis: This condition can cause joint pain and skin peeling (psoriasis), which might fit the patient's symptoms, especially if the skin peeling is part of a psoriatic rash.
- Do Not Miss Diagnoses
- Giant Cell Arteritis (GCA): This is a critical diagnosis to consider, especially if the patient is over 50, as it can lead to serious complications like blindness if not promptly treated. The presence of hip and shoulder pain, along with elevated inflammatory markers, already points towards PMR, but GCA can coexist with PMR.
- Vasculitis (e.g., Erythema Multiforme, Stevens-Johnson Syndrome): These conditions can cause skin peeling and are medical emergencies. Although less likely, they must be considered, especially if the skin symptoms are severe or accompanied by other systemic signs.
- Rare Diagnoses
- Dermatomyositis: An inflammatory disease characterized by skin rash and muscle weakness. The skin peeling could be part of a dermatomyositis rash, but this would typically be accompanied by significant muscle weakness.
- Paraneoplastic Syndromes: Rarely, the patient's symptoms could be related to an underlying malignancy, presenting with musculoskeletal and skin manifestations. This would be a consideration if other diagnoses are ruled out and there are other suggestive symptoms or findings.