What is Palindromic rheumatism?
Palindromic rheumatism is a rare type of inflammatory arthritis. It is characterized by episodes of joint pain & swelling involving the joints & at times, tissues surrounding the joints. At times, episodes are also associated with skin nodules.
The attacks of palindromic rheumatism last for a variable period, usually less than 24 hours. The attack starts suddenly & resolves spontaneously. The attacks are unpredictable & recur with variable frequency. In between the attacks, the pain & swelling completely disappears. The swelling may be so transient that the same may disappear by the time you reach the consultant's clinic; thus making the diagnosis difficult.
Does palindromic rheumatism lead to joint damage?
No. Palindromic rheumatism by itself does not lead to joint damage. However, 40- 45% patients of palindromic rheumatism may later develop rheumatoid arthritis. Rheumatoid arthritis may lead to joint damage. Some experts do consider palindromic rheumatism as an abortive form of Rheumatoid arthritis.
How is palindromic rheumatism diagnosed?
Palindromic rheumatism is a clinical diagnosis. There is no specific test for the diagnosis of palindromic rheumatism. Blood tests like ESR, CRP may be elevated in some patients. Rheumatoid factor & Anti CCP antibody is positive in a few patients. Those with a positive Anti CCP antibody have a higher risk of progression to rheumatoid arthritis*.
How is palindromic rheumatism treated?
Attacks of palindromic rheumatism are treated with NSAIDs, steroids (occasionally). Hydroxychloroquine is often used to prevent recurrent attacks. Colchicine & Sulphasalazine are occasionally used.
*Russell, A.S., Devani, A. and Maksymowych, WP. 2006. The role of anti-cyclic citrullinated peptide antibodies in predicting progression of palindromic rheumatism to rheumatoid arthritis. J. Rheumatol., 33:1240–2.