Differential Diagnosis for Bilateral Extreme Hand Pain and Stiffness

Single Most Likely Diagnosis

• Rheumatoid Arthritis (RA): This is a common autoimmune disorder that often presents with symmetric joint pain and stiffness, particularly in the hands. The bilateral nature of the symptoms and the involvement of joints are highly suggestive of RA.

Other Likely Diagnoses

• Osteoarthritis (OA): While OA can cause hand pain and stiffness, it typically affects the distal interphalangeal joints and the base of the thumb, and the symptoms may not be as symmetric as in RA.
• Psoriatic Arthritis (PsA): This condition can cause hand pain, stiffness, and swelling, often accompanied by skin and nail changes due to psoriasis.
• Systemic Lupus Erythematosus (SLE): SLE is an autoimmune disease that can cause joint pain and stiffness, among other systemic symptoms.

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 sudden onset of severe joint pain and stiffness, often with systemic symptoms like fever.
• Gout: Gouty arthritis can cause sudden, severe pain and stiffness, typically in one joint at a time, but it can become chronic and affect multiple joints.
• Carpal Tunnel Syndrome: This condition can cause hand pain, numbness, and stiffness, particularly at night, due to compression of the median nerve.

Rare Diagnoses

• Scleroderma: A chronic autoimmune disease that can cause hand pain, stiffness, and thickening of the skin.
• Ehlers-Danlos Syndrome: A group of genetic disorders that can affect the joints, causing hypermobility and pain.
• Relapsing Polychondritis: A rare autoimmune disorder that can cause cartilage inflammation, leading to joint pain and stiffness, among other symptoms.

Each of these diagnoses has a different set of implications for treatment and management, highlighting the importance of a thorough diagnostic evaluation.