Rheumatoid Arthritis: Or something else? Differential Diagnosis

Blood, blood-forming organs-immune system (D50-D90).

  • Löfgren syndrome – subtype of sarcoidosis; characteristic triad (simultaneous occurrence of three symptoms): erythema nodosum (synonyms: nodular erythema, dermatitis contusiformis, erythema contusiforme; plural: Erythemata nodosa; granulomatous inflammation of the subcutis (subcutaneous fat tissue), also known as panniculitis, and a painful nodule (red to blue-red color; later brownish). The overlying skin is reddened. Localization: both lower leg extensor sides, on the knee and ankle joints; less frequently on the arms or buttocks), bihilary lymphadenopathy and arthritis; primarily young people are affected.
  • Sarcoidosis (synonyms: Boeck’s disease; Schaumann-Besnier’s disease) – systemic disease of connective tissue with granuloma formation (skin, lungs, and lymph nodes); most common musculoskeletal manifestation is Löfgren’s syndrome (synonym: bilateral hilar lymphoma syndrome): see. o.

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Acromegaly – endocrinologic disorder caused by overproduction of growth hormone (somatotropic hormone (STH), somatotropin), with marked enlargement of the body end limbs or protruding parts of the body (acras), such as the hands, feet, lower jaw, chin, nose, and eyebrow ridges.
  • Amyloidosis – extracellular (“outside the cell”) deposits of amyloids (degradation-resistant proteins) that can lead to cardiomyopathy (heart muscle disease), neuropathy (peripheral nervous system disease), and hepatomegaly (liver enlargement), among other conditions.
  • Diabetes mellitus (diabetes) – here: diabetic arthropathy (Charcot arthropathy; softening of the bones of the foot and / or ankle with subsequent fractures (bone fractures) and deformities (malpositions)) due todiabetic neuropathy (diseases of the peripheral nervous system).
  • Hemochromatosis (iron storage disease) – symmetrical manifestation in the MCP (metacarpophalangeal) II and III joints with swelling and pain/arthralgia (joint pain).
  • Hypothyroidism (underactive thyroid gland).

Cardiovascular system (I00-I99)

Infectious and parasitic diseases (A00-B99).

  • Hepatitis C (viral inflammation of the liver).
  • Lyme arthritis (Lyme disease) – chronic progressive disease transmitted by tick bite, which is also manifested by joint pain; in mon- or oligoarthritis / affected are 4 or fewer joints (especially the knee joint).
  • Parvovirus B19 arthritis – joint inflammation following infection with parvovirus B19.
  • Tropheryma whipplei → Whipple’s disease: other organ systems may be affected in addition to the intestinal system (multisystem disease); clinical picture: Weight loss, enteropathic arthritis (oligoarthritis/occurrence of joint inflammation (arthritis) in fewer than 5 joints)/spondylarthropathy/sacroiliitis (inflammation of the sacroiliac joint between the sacrum and the ilium); most common initial symptom: 18%; may precede intestinal (“affecting the intestine”) symptoms by up to 10 years! ), diarrhea (diarrhea) to cardiac (heart) and CNS involvement.

Musculoskeletal system and connective tissue (M00-M99).

  • Arthritis urica – joint inflammation based on a disorder of uric acid metabolism:
  • Osteoarthritis (chronic degenerative joint changes with cartilage degradation) or activated osteoarthritis (inflammatory thrust of degenerative joint disease) [osteoarthritis] – the most common is finger polyarthrosis (affection of the basic joints and middle joints); Symptomatology: arthralgias (joint pain) especially during exercise under load.
  • Bouchard osteoarthritis – non-inflammatory disease that falls into the clinical picture of polyarthrosis (arthrosis); is often accompanied by Heberden’s arthrosis, but in contrast to this affects the finger middle joints
  • Brucella arthritis – joint inflammation after infection with the bacterium Brucella.
  • Caplan syndrome (synonyms: silicoarthritis Caplan-Collinet syndrome, silicoarthritis or rheumatoid pneumoconiosis) – rare combination of silica dust lung (silicosis) and symptoms of chronic polyarthritis referred. Affected are mainly workers in the coal industry.
  • CPPD(“calcium pyrophosphate crystal deposition disease”)-arthritis – leads in the area of the hand / finger joints and also the knee joints to the clinical picture of rheumatoid arthritis with often imposing bilateral (both sides), symmetrical and deforming polyarthritis.
  • Diabetic arthropathy / joint disease (Charcot arthropathy): diabetic neuropathy (nerve disease) – as long-term consequences of poorly adjusted diabetes mellitus type 2 – is the most common cause of this clinical picture that is associated with neurotraumatic and neovascular changes in the bone; esp. affected is the foot skeleton (mainly metatarsus but also calcaneus (heel bone) and lower and upper ankle joint (USG, OSG).
  • Felty syndrome – special form of chronic polyarthritis. (Symptoms: chronic polyarthritis, blood count changes (thrombocytopenia and leukopenia) and hepatosplenomegaly (liver and spleen enlargement). Felty’s syndrome usually occurs after a prolonged course of chronic polyarthritis.
  • Fibromyalgia syndrome (soft tissue symptomatology) – widespread syndrome leading to pain throughout the musculoskeletal system and additionally characterized by stiffness, sensory disturbances, sleep disturbances and chronic fatigue.
  • Heberden’s arthritis – idiopathic osteoarthritis of the finger end joints (distal interphalangeal joints) with the formation of Heberden’s nodes (bicuspid, cartilaginous-bony growths on the extensor side of the base of the finger end links).
  • Infectious arthritis – spontaneously occurring acute arthritis; at 60 percent, staphylococci are the most common causative agent of infectious arthritis
  • Juvenile idiopathic arthritis (JIA; synonyms: juvenile rheumatoid arthritis (JRA), juvenile chronic arthritis, JCA) – rheumatoid arthritis of adolescent age.
  • Crystal arthropathies – joint disease in which there is deposition of crystalline metabolites in the joint cavity (eg, uric acid crystals in gout).
  • Late onset rheumatoid arthritis – arthritis that occurs only at an older age (after the age of 60).
  • Lupus erythematosus – systemic autoimmune disease from the group of collagenoses.
  • Malignant rheumatoid arthritis – severe form of rheumatoid arthritis with rapid joint destruction.
  • Bekhterev’s disease (synonyms: ankylosing spondylitis, ankylosing spondylitis; Latinized Greek: spondylitis “inflammation of the vertebrae” and ankylosans “stiffening”); symptomatology: pain in the sacroiliac joint (sacroiliac/intestinal joints) with a feeling of stiffness especially in the early morning.
  • Behçet’s disease (synonym: Adamantiades-Behçet’s disease; Behçet’s disease; Behçet’s aphthae) – multisystem disease from the rheumatic form circle, which is associated with recurrent, chronic vasculitis (vascular inflammation) of the small and large arteries and mucosal inflammation; The triad (the occurrence of three symptoms) of aphthae (painful, erosive mucosal lesions) in the mouth and aphthous genital ulcers (ulcers in the genital region), as well as uveitis (inflammation of the middle eye skin, which consists of the choroid (choroid), the ray body (corpus ciliare) and the iris) is stated as typical for the disease; a defect in cellular immunity is suspected
  • Still’s disease – systemic form of juvenile rheumatoid arthritis; (symptoms: systemic signs of inflammation and organ involvement are prominent – high to very high fever of the so-called septic type, i.e. the fever occurs daily in high fever spikes, between the individual fever spikes the temperature then completely normalizes again; generalized lymphadenopathy (enlargement of lymph nodes in many regions of the body), hepato-splenomegaly (enlargement of liver and spleen), sharp increase in inflammatory parameters (ESR (erythrocyte sedimentation rate) and c-reactive protein (CRP), leukocytosis (increase in the number of white blood cells; the number can reach such high values that one initially also thinks of the possibility of leukemia (so-called leukemoid reaction), pleurisy (inflammation of pleura) and pericarditis (pericardium), iritis (severe, recurrent inflammation of the iris) with the risk of blindness.
  • Psoriatic arthritis – inflammatory joint disease predominantly in the hands and feet (in psoriasis) in which erosive (tissue loss) and osteoproliferative (bone-forming) changes appear side by side; symptomatology: painful joint swelling of the hands and feet (metacarpo- resp. Metatarsophalangeal joints, proximal and distal interphalangeal joints) in the sense of dactylitis (Latin: daktyl = fingers or toes and “itis” = inflammation; finger inflammation or also toe inflammation), which lead from the appearance to the so-called “sausage fingers”.
  • Reactive arthritis (synonym: post-infectious arthritis / joint inflammation) – second disease after gastrointestinal (gastrointestinal tract concerning), urogenital (urinary and genital organs concerning) or pulmonary (lungs concerning) infections; refers to an arthritis, where pathogens in the joint (usually) can not be found (sterile synovialitis).
  • Reiter’s disease (synonyms: Reiter’s syndrome; Reiter’s disease; arthritis dysenterica; polyarthritis enterica; postenteritic arthritis; posturethritic arthritis; undifferentiated oligoarthritis; urethro-oculo-synovial syndrome; Fiessinger-Leroy syndrome; English Sexually acquired reactive arthritis (SARA)) – special form of a “reactive arthritis” (see above. ); secondary disease after gastrointestinal or urogenital infections, characterized by the symptoms of Reiter’s triad; seronegative spondyloarthropathy, which is triggered especially in HLA-B27 positive persons by an intestinal or urinary tract disease with bacteria (mostly chlamydia); Can manifest as arthritis (joint inflammation), conjunctivitis (conjunctivitis), urethritis (urethritis) and partly with typical skin changes.
  • Rhizarthrosis – arthritis of the thumb saddle joint.
  • Ross River virus polyarthritis – joint inflammation affecting multiple joints due to a viral infection with the Ross River virus.
  • Sharp syndrome – chronic inflammatory connective tissue disease that includes symptoms of several collagenoses such as lupus erythematosus, scleroderma, or polymyositis
  • Systemic lupus erythematosus (SLE) – systemic disease that affects the skin and connective tissue of the vessels, leading to vascular inflammation (vasculitides) of numerous organs such as the heart, kidneys, or brain
  • Virus-associated arthritis – e.g. due tohepatitis B virus (HBV), hepatitis C virus (HCV) and human parvovirus B19 (HPV B19) infections (relatively common).

Neoplasms – tumor diseases (C00-D48).

  • Paraneoplastic arthritic complaints in cancer.

Psyche – nervous system (F00-F99; G00-G99).

  • Idiopathic carpal tunnel syndrome – nerve compression syndrome of the median nerve, that is, on the inside of the wrist, the nerve supplying the hand is constricted by connective tissue structures as it passes through the carpal canal; affects mainly postmenopausal women (symptoms: paresthesias (numbness), pain, and loss of grip strength).

Injuries, poisonings, and other sequelae of external causes (S00-T98).

  • Trauma (injuries)

Further

  • Chronic overload of the affected joints