What other diseases should be excluded prior to making the diagnosis of Rheumatoid Arthritis

What other diseases should be excluded prior to making the diagnosis of Rheumatoid Arthritis?

Common diseases

Seronegative spondyloarthropathies, calcium pyrophosphate deposition disease, connective tissue diseases (systemic lupus erythematosus [SLE], scleroderma, polymyositis, vasculitis, mixed connective tissue disease, polymyalgia rheumatica), osteoarthritis (OA), viral infection (EBV, HIV, hepatitis B, parvovirus, rubella, hepatitis C), polyarticular gout, fibromyalgia, reactive arthritis.

Uncommon diseases

Hypothyroidism, relapsing polychondritis, subacute bacterial endocarditis, rheumatic fever, hemochromatosis, sarcoidosis, hypertrophic osteoarthropathy, Lyme disease, hyperlipoproteinemias (types II, IV), amyloid arthropathy, hemoglobinopathies (sickle cell disease), malignancy and paraneoplastic syndrome, and Behçet’s disease.

Rare diseases

Familial Mediterranean fever, Whipple’s disease, multicentric reticulohistiocytosis, angioimmunoblastic lymphadenopathy, remitting seronegative symmetrical synovitis with pitting edema (RS3PE), and SAPHO—synovitis, acne, pustulosis, hyperostosis, and osteitis.

Pearl : A clinician should consider a diagnosis other than RA particularly in patients who have an asymmetric arthritis, migrating pattern, predominantly large-joint arthritis, distal interphalangeal (DIP) joint involvement, rashes, back disease, renal disease, leukopenia, or hypocomplementemia.

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