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Differential diagnosisSeveral other medical conditions can resemble RA, and usually need to be distinguished from it at the time of diagnosis:
  • Crystal induced arthritis(gout, and pseudogout) - usually involves particular joints and can be distinguished with aspiration of joint fluid if in doubt
  • Osteoarthritis - distinguished with X-rays of the affected joints and blood tests
  • Systemic lupus erythematosus (SLE) - distinguished by specific clinical symptoms and blood tests (antibodies against double-stranded DNA)
  • One of the several types of psoriatic Arthritis resembles RA - nail changes and skin symptoms distinguish between them
  • Lyme disease causes erosive arthritis and may closely resemble RA - it may be distinguished by blood test in endemic areas
  • Reactive arthritis (previously Reiter's disease) - asymmetrically involves heel, sacroiliac joints, and large joints of the leg. It is usually associated with urethritis, conjunctivitis, iritis, painless buccal ulcers, and keratoderma blennorrhagica.
  • Ankylosing spondylitis - this involves the spine and is usually diagnosed in males, although a RA-like symmetrical small-joint polyarthritis may occur in the context of this condition.

Rarer causes that usually behave differently but may cause joint pains:

  • Sarcoidosis, amyloidosis, and Whipple's disease can also resemble RA.
  • Hemochromatosis may cause hand joint arthritis.
  • Acute rheumatic fever can be differentiated from RA by a migratory pattern of joint involvement and evidence of antecedent streptococcal infection. Bacterial arthritis (such as streptococcus) is usually asymmetric, while RA usually involves both sides of the body symmetrically.
  • Gonococcal arthritis (another bacterial arthritis) is also initially migratory and can involve tendons around the wrists and ankles.(Source Wikipedia)
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