Version May 2024
| Diagnosis | Distinguishing features |
| Infection | |
| Viral infection | Fever, respiratory or gastrointestinal symptoms, viral diagnostic testing |
| Bacterial infection | Hypotension, rash, heart murmur, leukocytosis, bacteremia |
| Spirochetal infection | Rash, Lyme, or RPR serology |
| Noninflammatory pain syndrome | |
| Fibromyalgia | Tender points, nonrestorative sleep, normal test results |
| Chronic fatigue syndrome, also known as myalgic encephalomyelitis/chronic fatigue syndrome | Longstanding, profound fatigue without other explanation |
| Systemic rheumatic disease and autoinflammatory disease | |
| Polymyalgia rheumatica | Acute onset of proximal myalgia, morning stiffness, over age 55, high ESR, prompt improvement with low-dose glucocorticoids |
| Polymyositis/dermatomyositis | Proximal weakness, rash, elevated CK, myopathic EMG, muscle histology |
| Rheumatoid arthritis | Chronic, symmetric polyarthritis, positive RF, and/or anti-cyclic citrullinated peptide antibody |
| Systemic lupus erythematosus | Polyarthritis, rash, nephritis, serositis, positive ANA antibody, anti-double-stranded DNA antibody, and/or anti-Smith antibody |
| Spondyloarthropathy | History of psoriasis, colitis, conjunctivitis, urethritis, low back pain |
| Vasculitis | Multisystem inflammatory disease, palpable purpura, paresthesias, focal neurologic deficit, cavitary pulmonary nodules, active urinary sediment, positive ANCA |
| Metabolic | |
| Osteomalacia | Reduced 25-hydroxy vitamin D |
| Metabolic myopathy | Exercise intolerance, family history, muscle weakness, muscle biopsy results |
| Scurvy | Petechiae, ecchymoses, follicular hyperkeratosis, corkscrew hairs, vitamin C deficiency |
| Endocrinologic | |
| Familial Mediterranean fever | Episodic fever, serositis, arthralgia, abdominal pain, onset during childhood |
| Neuropathic | Paresthesias, focal neurologic deficits |
| Hypothyroidism | Elevated TSH, decreased free T4 |
| Adrenal insufficiency | Low-serum cortisol, 24-hour urine cortisol, and/or abnormal ACTH stimulation test |
| Medications | |
| History of new medication use, especially statins | |
| Psychiatric | |
| Prior history of mood disorder, depressed affect | |
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