Differential Diagnosis
The patient's symptoms of aching pain and stiffness involving her neck, shoulders, lower back, and hips, along with difficulty sleeping, fatigue, and headaches, suggest a condition that affects the musculoskeletal system and possibly has systemic implications. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Fibromyalgia: This condition is characterized by widespread musculoskeletal pain, fatigue, sleep, memory, and mood issues. The patient's symptoms of aching pain, stiffness, difficulty sleeping, and fatigue are classic for fibromyalgia. On physical exam, multiple tender joints are likely to be found, which aligns with the tender points seen in fibromyalgia.
Other Likely diagnoses
- Rheumatoid Arthritis (RA): Although RA typically presents with swollen and tender joints, it can also cause systemic symptoms like fatigue and may involve the spine and larger joints, leading to stiffness and pain. However, the absence of swollen joints in the question makes this less likely.
- Osteoarthritis: This condition could explain the joint pain and stiffness, especially in the hips and lower back, but it typically doesn't cause widespread pain or systemic symptoms like fatigue and difficulty sleeping to the same extent as fibromyalgia.
- Ankylosing Spondylitis: This inflammatory disease can cause pain and stiffness in the spine and hips, but it often presents with limited range of motion of the spine and may not fully account for the widespread nature of the patient's symptoms.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Multiple Myeloma: A type of blood cancer that can cause bone pain, fatigue, and anemia. Although less likely, it's crucial to consider due to its severe implications.
- Metastatic Cancer: Cancer that has spread to bones can cause widespread pain and other systemic symptoms. This is another critical diagnosis not to miss due to its potential severity.
- Lyme Disease: In its later stages, Lyme disease can cause arthritis and neurological symptoms, including fatigue and headaches. Given its potential for serious complications if untreated, it should be considered.
Rare diagnoses
- Polymyalgia Rheumatica: An inflammatory disorder that causes muscle pain and stiffness, typically in the shoulders and hips. It's less common and usually affects older adults, making it a less likely consideration for a 40-year-old.
- Psoriatic Arthritis: This condition combines the swollen, scaly skin of psoriasis with joint pain and arthritis. While it could explain some of the patient's symptoms, the absence of skin symptoms in the question makes it less likely.
- Sjögren's Syndrome: An autoimmune disorder that can cause joint pain, fatigue, and dry eyes and mouth. It's less common and might not fully explain the patient's primary complaints of musculoskeletal pain and stiffness.