Differential Diagnosis for Bilateral Hand Joint Pain in a 21-year-old Female
Single Most Likely Diagnosis
- Osteoarthritis (OA): Although less common in young individuals, OA can occur, especially if there's a history of trauma or repetitive strain on the joints. Normal labs, including CRP and RF, make inflammatory causes less likely, pointing towards a degenerative condition like OA.
- Overuse or Repetitive Strain Injury: Given the patient's age and the absence of inflammatory markers, overuse or repetitive strain injuries (e.g., from sports, typing, or other repetitive activities) could be a common cause of bilateral hand joint pain.
Other Likely Diagnoses
- Psoriatic Arthritis: Despite normal RF, psoriatic arthritis (PsA) is a consideration, especially if the patient has psoriasis or a family history of it. PsA can present with joint pain and normal inflammatory markers.
- Reactive Arthritis: This condition can occur after certain infections and might not always present with elevated inflammatory markers. A detailed history of recent infections is necessary.
- Tendinitis or Bursitis: Inflammation of the tendons or bursae around the joints can cause pain and is common in young, active individuals.
Do Not Miss Diagnoses
- Lyme Arthritis: Caused by Borrelia burgdorferi, Lyme disease can lead to arthritis, particularly in the knees but also potentially in the hands. It's crucial to consider this diagnosis, especially if the patient has been in areas where Lyme disease is common.
- Gonococcal Arthritis: A sexually transmitted infection that can cause septic arthritis, gonococcal arthritis is a critical diagnosis not to miss due to its potential for severe joint damage and the need for prompt antibiotic treatment.
- Sarcoidosis: Although less common, sarcoidosis can cause joint pain and might not always present with elevated inflammatory markers. It's a diagnosis to consider, especially if other systemic symptoms are present.
Rare Diagnoses
- Hemochromatosis: A genetic disorder leading to iron overload, which can cause arthritis, particularly in the second and third metacarpophalangeal joints. It's rare but important to consider due to its potential for other systemic complications.
- Sjögren's Syndrome: An autoimmune disorder that can cause joint pain, among other symptoms like dry eyes and mouth. It's less common and might not always present with positive RF or elevated CRP.
- Relapsing Polychondritis: A rare autoimmune disorder that can cause cartilage inflammation, leading to joint pain among other symptoms. It's a diagnosis to consider if other causes have been ruled out and the patient presents with additional symptoms like ear or nose cartilage involvement.