Presenting Complaints

• Swollen and painful joints for the past 2 months

History of Presenting Complaint

• The patient, a 31-year-old male, reports that he has been experiencing swelling and pain in his joints, particularly in his knees, ankles, and wrists, for the past 2 months.
• The swelling and pain are worse in the mornings and tend to improve somewhat as the day goes on, but the symptoms never fully resolve.
• He denies any recent injuries or trauma to the affected joints.
• The patient reports that the joint pain is accompanied by occasional stiffness and limited range of motion, which makes it difficult for him to perform his daily activities.
• He also mentions that he has been feeling more fatigued than usual and has noticed a slight fever in the evenings.

Significant Positives & Negatives For Differentials

Rheumatoid Arthritis

Positives:

• Symmetrical joint involvement (knees, ankles, wrists)
• Morning stiffness and joint pain that improves throughout the day
• Positive family history (mother with rheumatoid arthritis)
• Lack of recent trauma or injury

Negatives:

• Absence of extra-articular manifestations (e.g., rashes, eye problems, gastrointestinal issues)
• Lack of response to over-the-counter anti-inflammatory medications

Psoriatic Arthritis

Positives:

• Symmetrical joint involvement (knees, ankles, wrists)
• Lack of response to over-the-counter anti-inflammatory medications

Negatives:

• Absence of skin rashes or nail changes typical of psoriasis
• Lack of a personal or family history of psoriasis

Gout

Positives:

• Acute joint pain and swelling
• Lack of response to over-the-counter anti-inflammatory medications

Negatives:

• Absence of localized joint involvement (typically affects a single joint)
• Symmetrical joint involvement (knees, ankles, wrists)

Osteoarthritis

Positives:

• Joint pain and swelling
• Lack of response to over-the-counter anti-inflammatory medications

Negatives:

• Young age of the patient (31 years old)
• Symmetrical joint involvement (knees, ankles, wrists)

Reactive Arthritis

Positives:

• Acute joint pain and swelling
• Lack of response to over-the-counter anti-inflammatory medications

Negatives:

• Absence of recent infections or gastrointestinal symptoms
• Symmetrical joint involvement (knees, ankles, wrists)

Past Medical History

• The patient has no significant past medical history.
• He reports that he has not had any prior issues with joint swelling or pain.

Drug/Medication History

• The patient is not taking any regular medications.
• He has tried over-the-counter anti-inflammatory medications, such as ibuprofen, to help manage the joint pain, but they have provided only temporary relief.

Social History

• The patient works as an office administrator and spends most of his day sitting at a desk.
• He denies any history of smoking or excessive alcohol consumption.
• He is married and has two young children.

Family History

• The patient's mother has been diagnosed with rheumatoid arthritis.
• There is no other significant family history of autoimmune or rheumatic diseases.

Systems Review

• The patient reports no other significant symptoms, aside from the joint swelling and pain.
• He denies any rashes, eye problems, or gastrointestinal issues.
• His appetite and sleep patterns have been normal.

Ideas, Concerns & Expectations

• The patient is concerned that the joint swelling and pain may be a sign of a more serious underlying condition.
• He is hoping the doctor can provide a diagnosis and recommend appropriate treatment to alleviate his symptoms.

Case Presentation

Based on the presented case information and the analysis of the differentials, the most likely diagnosis is rheumatoid arthritis. The patient's symmetrical joint involvement, morning stiffness, positive family history, and lack of response to over-the-counter anti-inflammatory medications are all highly suggestive of rheumatoid arthritis. While the absence of extra-articular manifestations is a negative, the overall clinical picture strongly points to rheumatoid arthritis as the most likely diagnosis.