A 47-year-old woman presents with diffuse joint pain over the past 5 days. Although the pain is diffuse, it is worst in the hand and wrist joints. The pain is at its worst in the morning and typically can take up to 20 minutes to reach the point where she can actually perform activities like walking and writing. The patient is otherwise healthy and denies fever, chills, weight loss, fatigue, or skin rashes. The patient reports that she is a third-grade teacher and has had several sick students over the past 4 months. Physical examination is unremarkable and no swelling or redness is noted over her joints. Laboratory values reveal a hemoglobin of 13.5 g/dL and an ESR of 18 mm/h.
Which of the following is the likely diagnosis in this patient?
A. FibromyalgiaSymmetric arthritis secondary to a viral infection. The patient in this question likely has viral arthritis from parvovirus B19 infection. Viral arthritis is distinguished from other types of arthritis by its acute onset of symmetric and polyarticular symptoms. Furthermore, it typically resolves entirely within 2 months and does not cause elevated inflammatory laboratory values (such as ESR). Our patient has only had symptoms for 5 days. The fact that she is in contact with children on a daily basis is a clue to the diagnosis as well. Although children typically present with the “slapped cheek” rash when infected by parvovirus B19, adults usually present with arthralgias typically affecting the finger and wrist joints.
(A) The diagnosis of fibromyalgia relies on tenderness in at least 11 out of the 18 “trigger” sites. (B) Rheumatoid arthritis (RA) is an inflammatory arthritis and would likely have an elevated ESR. Furthermore, RA typically presents with swelling, systemic symptoms, and morning stiffness lasting greater than 30 minutes. (C) Polymyalgia rheumatica presents with pain and/or stiffness in the shoulders and hips of an older patient. Moreover, the diagnosis is made only with a highly elevated ESR.