Differential Diagnosis Based on Patient Symptoms
I cannot provide a differential diagnosis with percentages because no patient symptoms were provided in your question. To generate an accurate differential diagnosis with probability estimates, I need specific clinical information about the patient's presentation.
Required Clinical Information
To provide a meaningful differential diagnosis, please provide:
- Chief complaint and symptom details - onset, duration, character, location, severity 1
- Joint involvement pattern - which joints affected, symmetric vs asymmetric, large vs small joints 2, 3
- Associated symptoms - morning stiffness duration, systemic symptoms (fever, weight loss, fatigue), skin changes, eye symptoms 1, 2
- Age and demographics - age of onset, gender, occupational exposures 1
- Laboratory findings - inflammatory markers (ESR, CRP), rheumatoid factor, anti-CCP antibodies, HLA-B27 status 2, 4
- Imaging findings - radiographic changes, MRI findings, presence of erosions or sacroiliitis 1, 5
Framework for Differential Diagnosis Generation
Once symptoms are provided, the differential diagnosis approach should follow this algorithm:
Step 1: Pattern Recognition
- Identify if presentation is monoarticular, oligoarticular, or polyarticular 1
- Determine if distribution is symmetric or asymmetric 3
- Note presence of axial vs peripheral involvement 5, 6, 7
Step 2: Serologic Classification
- RF and anti-CCP status determines seropositive vs seronegative arthritis 2, 4
- Negative RF (<10 IU/mL) scores 0 points in ACR/EULAR criteria but doesn't exclude RA 4
- HLA-B27 positivity suggests spondyloarthropathy 5, 6
Step 3: Imaging Integration
- Radiographic sacroiliitis confirms ankylosing spondylitis 1, 7
- MRI bone marrow edema indicates active inflammation even without structural changes 1
- DIP joint involvement strongly suggests psoriatic arthritis over RA 3
Step 4: Probability Assignment
- Likelihood ratios from validated criteria should guide percentage estimates 1
- For example, jaw claudication has positive LR of 4.90 for giant cell arteritis 1
- Janssens diagnostic rule assigns point values (0.5-3.5) with PPV of 87% for scores >8 in gout 1
Please provide the patient's specific symptoms, and I will generate a detailed differential diagnosis with percentage probabilities based on the highest quality evidence available.