Differential diagnosis

It is important to realise that the presence or absence of rheumatoid factor is of prognostic and NOT diagnostic value.

The differential diagnosis or early RA includes:

• viral arthritis (e.g. parvovirus, rubella, hepatitis B)
• reactive arthritis (e.g. post-infection: throat, gut, sexually acquired)
• seronegative spondyloarthropathy (e.g. psoriatic, ankylosing spondylitis, Reiter's disease, inflammatory bowel disease)
• connective tissue disease (e.g. systemic lupus erythematosus, scleroderma)
• polymyalgia rheumatica
• polyarticular gout
• osteoarthritis
• septic arthritis
• fibromyalgia
• medical conditions presenting with arthropathy (e.g. sarcoidosis, thyroid disease, infective endocarditis, haemochromatosis, diabetic cheiroarthropathy, paraneoplastic syndromes, multiple myeloma)
• Lyme disease

Reference:

1. MeReC Bulletin 2007;17(5):1-8.