Differential Diagnosis for Acute Onset Symmetric Polyarthralgia in a 41-year-old Female
- The following differential diagnosis is organized into categories to guide further investigation and management.
Single Most Likely Diagnosis
- Rheumatoid Arthritis (RA): This is the most likely diagnosis due to the symmetric nature of the polyarthralgia, which is a hallmark of RA. The acute onset also fits, as RA can start suddenly in some cases.
Other Likely Diagnoses
- Systemic Lupus Erythematosus (SLE): SLE can present with symmetric polyarthralgia and has a wide range of systemic manifestations. It's more common in women and can have an acute onset.
- Seronegative Spondyloarthropathies: Conditions like psoriologic arthritis, reactive arthritis, and enteropathic arthritis can present with polyarthralgia, though they might not always be symmetric.
- Autoimmune Thyroiditis: Conditions like Hashimoto's thyroiditis can cause polyarthralgias and are common in women.
Do Not Miss Diagnoses
- Septic Arthritis: Although less likely, septic arthritis is a medical emergency that requires immediate attention. It can present with acute onset of joint pain, and while it's typically asymmetric, it's crucial not to miss due to its potential for rapid joint destruction and systemic infection.
- Crystal Arthropathies (Gout, Pseudogout): These conditions can cause acute, severe joint pain and, although often asymmetric, can sometimes present with symmetric involvement.
- Lyme Arthritis: In endemic areas, Lyme disease can cause symmetric polyarthralgia and is crucial to diagnose due to its treatable nature and potential for long-term sequelae if missed.
Rare Diagnoses
- Adult-Onset Still's Disease: A rare condition characterized by high fevers, rash, and symmetric polyarthralgia. It's a diagnosis of exclusion but should be considered in the appropriate clinical context.
- Relapsing Polychondritis: An autoimmune condition that can cause joint pain among other symptoms like cartilage inflammation. It's rare but should be considered in patients with a broader range of symptoms.
- Sarcoid Arthritis: Part of sarcoidosis, which can cause symmetric polyarthralgia among other systemic manifestations. It's less common but should be considered, especially if other systemic symptoms are present.