Vitamin D deficiency differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
Vitamin D deficiency must be differentiated from other diseases that cause generalized muscle and [[bone pain]], such as [[fibromyalgia]], [[chronic fatigue syndrome]], [[polymyalgia rheumatica]], and [[osteoarthritis]]. <ref name="Holick2007">{{cite journal|last1=Holick|first1=Michael F.|title=Vitamin D Deficiency|journal=New England Journal of Medicine|volume=357|issue=3|year=2007|pages=266–281|issn=0028-4793|doi=10.1056/NEJMra070553}}</ref><ref name="pmid18400738">{{cite journal |vauthors=Holick MF, Chen TC |title=Vitamin D deficiency: a worldwide problem with health consequences |journal=Am. J. Clin. Nutr. |volume=87 |issue=4 |pages=1080S–6S |year=2008 |pmid=18400738 |doi= |url=http://www.ajcn.org/cgi/pmidlookup?view=long&pmid=18400738}}</ref> | |||
==Differentiating vitamin D deficiency from other diseases== | |||
Vitamin D deficiency must be differentiated from other conditions that may cause generalized muscle and [[bone pain]]. The following table summarizes different diagnoses and how to differentiate them. | |||
==Differentiating | {| class="wikitable" | ||
! style="font-weight: bold;" | Disease | |||
! style="font-weight: bold;" | Differentiating signs and symptoms | |||
! style="font-weight: bold;" | Diagnostic findings | |||
|- | |||
| style="font-weight: bold;" | [[Vitamin D deficiency]] | |||
| | |||
* Nonspecific musculoskeletal pain | |||
* Muscle weakness | |||
* Symmetric low back pain | |||
* Throbbing bone pain | |||
| | |||
* Low serum 25(OH)D level | |||
* High PTH level | |||
|- | |||
|style="font-weight: bold;" | [[Fibromyalgia]]<ref name="Goldenberg2004">{{cite journal|last1=Goldenberg|first1=Don L.|title=Management of Fibromyalgia Syndrome|journal=JAMA|volume=292|issue=19|year=2004|pages=2388|issn=0098-7484|doi=10.1001/jama.292.19.2388}}</ref> | |||
| | |||
* Symptoms have been present at a similar level for at least 3 months. | |||
* Chronic [[musculoskeletal pain]] with multiple tender points | |||
* [[Stiffness]], [[numbness]], and [[fatigue]] | |||
* [[Headaches]] | |||
* [[Sleep disorder]] | |||
| | |||
*All lab tests are normal | |||
|- | |||
|style="font-weight: bold;" | [[Chronic fatigue syndrome]] | |||
|Fatigue plus 4 of the following symptoms: | |||
*Short-term [[memory loss]] | |||
*[[Sore throat]] | |||
*Tender [[lymph nodes]] in the neck or armpit | |||
*[[Muscle pain]] | |||
*[[Joint pain]] without [[swelling]] or [[Redness of the skin|redness]] | |||
*[[Headaches]] | |||
*[[Insomnia]] | |||
*[[Malaise]] | |||
| | |||
*Diagnosis of exclusions | |||
*Symptoms must present for more than 6 months | |||
|- | |||
|style="font-weight: bold;" | [[Polymyalgia rheumatica]] | |||
| | |||
* Older at onset | |||
* Generalized [[stiffness]] | |||
| | |||
* An elevated [[erythrocyte sedimentation rate]] ([[ESR]]) | |||
* An elevated [[C-reactive protein]] (CRP) | |||
* Response to [[corticosteroids]] | |||
|- | |||
|style="font-weight: bold;" | [[Osteoarthritis]]<ref name="pmid16889509">{{cite journal |vauthors=Hollander AP, Dickinson SC, Sims TJ, Brun P, Cortivo R, Kon E, Marcacci M, Zanasi S, Borrione A, De Luca C, Pavesio A, Soranzo C, Abatangelo G, Schmoldt A, Benthe HF, Haberland G, Nakaya N, Sugano N, Nishi A, Tsukada K, Frankle RT, Stein JM, Katz B, Miledi R |title=Maturation of tissue engineered cartilage implanted in injured and osteoarthritic human knees |journal=Tissue Eng. |volume=12 |issue=7 |pages=1787–98 |year=2006 |pmid=16889509 |doi=10.1089/ten.2006.12.1787 |url=}}</ref> | |||
| | |||
* Localized [[joint pain]] | |||
* Restricted to affect joints | |||
* Older at onset | |||
| | |||
* [[X-ray]] of the involved joints demonstrate degenerative changes | |||
|} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 19:34, 2 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Vitamin D deficiency must be differentiated from other diseases that cause generalized muscle and bone pain, such as fibromyalgia, chronic fatigue syndrome, polymyalgia rheumatica, and osteoarthritis. [1][2]
Differentiating vitamin D deficiency from other diseases
Vitamin D deficiency must be differentiated from other conditions that may cause generalized muscle and bone pain. The following table summarizes different diagnoses and how to differentiate them.
| Disease | Differentiating signs and symptoms | Diagnostic findings |
|---|---|---|
| Vitamin D deficiency |
|
|
| Fibromyalgia[3] |
|
|
| Chronic fatigue syndrome | Fatigue plus 4 of the following symptoms:
|
|
| Polymyalgia rheumatica |
|
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| Osteoarthritis[4] |
|
|
References
- ↑ Holick, Michael F. (2007). "Vitamin D Deficiency". New England Journal of Medicine. 357 (3): 266–281. doi:10.1056/NEJMra070553. ISSN 0028-4793.
- ↑ Holick MF, Chen TC (2008). "Vitamin D deficiency: a worldwide problem with health consequences". Am. J. Clin. Nutr. 87 (4): 1080S–6S. PMID 18400738.
- ↑ Goldenberg, Don L. (2004). "Management of Fibromyalgia Syndrome". JAMA. 292 (19): 2388. doi:10.1001/jama.292.19.2388. ISSN 0098-7484.
- ↑ Hollander AP, Dickinson SC, Sims TJ, Brun P, Cortivo R, Kon E, Marcacci M, Zanasi S, Borrione A, De Luca C, Pavesio A, Soranzo C, Abatangelo G, Schmoldt A, Benthe HF, Haberland G, Nakaya N, Sugano N, Nishi A, Tsukada K, Frankle RT, Stein JM, Katz B, Miledi R (2006). "Maturation of tissue engineered cartilage implanted in injured and osteoarthritic human knees". Tissue Eng. 12 (7): 1787–98. doi:10.1089/ten.2006.12.1787. PMID 16889509.