Palindromic Rheumatism Print Page

Overview

Palindromic Rheumatism is a condition with intermittent short lived attacks of joint pain which resolve on their own. It was first described in the 1940s. Its name tries to describe its presentation, but does this poorly.

Frequently Asked Questions

What is Palindromic Rheumatism?

Palindromic Rheumatism (PR) is an autoimmune disease, meaning the immune system attacks the joints for reasons we do not yet understand, causing intermittent and self-resolving inflammation.

How common is Palindromic Rheumatism?

It is a relatively uncommon condition, with the exact number still unclear. At most, it affects about 0.5% of the population, or about half the amount of rheumatoid arthritis. It may be less common than that.

What causes PR?

It remains unclear. PR is felt to be a result of both genetic and environmental factors resulting in abnormalities in the immune system.

What are typical symptoms of Palindromic Rheumatism?

Sudden onset of joint pain, stiffness, redness, heat and swelling.
It can affect 1 or a few joints during a flare.
Regardless of any treatment, it will resolve on its own within 2-3 days.
Flares will happen again from time to time. It can happen a few times a month or an attack per year. It can affect the same or different joints in each flare.

I have some of the symptoms listed above. Does that mean I could have palindromic rheumatism?

While it is possible, there are other conditions which are more common that are associated with one or more of the symptoms or signs listed above. In particular, gout can behave similarly. It is important to work with your healthcare team to differentiate between gout and palindromic rheumatism to ensure you receive the right treatment.

How is Palindromic Rheumatism diagnosed then?

Palindromic Rheumatism is a clinical diagnosis. In many cases, your rheumatologist will not see you during an attack as the attacks are not frequent and/or resolve quickly. It is important your rheumatologist performs a detailed history and physical examination, and reviews various blood work and imaging studies. It is the right combination of findings from your history, exam and tests which help determine if in fact you may have PR.

Is there a blood test that can diagnosis PR?

Many individuals with palindromic rheumatism have completely normal bloodwork and imaging studies. Ultimately, this is a good thing. Some patients will have a positive anti-CCP antibody test or Rheumatoid Factor. While these tests are not diagnostic of PR, in the right setting, they can help make a diagnosis. In some cases, taking fluid out of a swollen joint for analysis may help a diagnosis, but often it is to rule out other possibilities rather than something in the fluid which can definitely diagnose PR.

I have been diagnosed with palindromic rheumatism? How is it treated?

Treatment depends on the frequency of your attacks as well as the antibody markers in your blood.
If your attacks are not frequent, your blood markers are normal and you do not want to take medication all the time, treating PR with anti-inflammatories (NSAIDs) can be a very effective and reasonable first choice.
If your attacks are more frequent, taking a medication to prevent attacks may be better for you. Disease Modifying Anti-Rheumatic Drugs (DMARDs) are used in this case, with hydroxychloroquine often used as the first choice treatment.
Positive antibody tests, such as CCP and RF, can increase your risk of PR transforming into Rheumatoid Arthritis. To reduce the risk of this happening, patients are often encouraged to use a DMARD such as hydroxychloroquine, even if the frequency of attacks is lower.

What is the prognosis for Palindromic Rheumatism?

In most cases, the symptoms of palindromic rheumatism can be well controlled during the attack or prevented entirely with the regular use of DMARD medication. For some patients, PR can transform into rheumatoid arthritis. Compared to PR, joint involvement in rheumatoid arthritis is more persistent, and will not resolve over a few days. In these cases, your rheumatologist will work with you to ensure you receive appropriate DMARD treatment so the RA can go into remission.