Palindromic Rheumatism

Original Editor - Pacifique Dusabeyezu  

Top Contributors - Pacifique Dusabeyezu, Habibu Salisu Badamasi and Kim Jackson  

Introduction

Palindromic rheumatism (PR) is an intermittent disease characterized by recurring, self-resolving attacks of inflammation in the articular and periarticular tissues. These attacks usually affect only one joint and can last from a few hours to a few days. Interestingly, during the attacks, patients do not experience any symptoms. The joints most commonly involved in these attacks are the knees, wrists, metacarpophalangeal joints, and proximal interphalangeal (PIP) joints.

The key distinguishing feature between PR and Rheumatoid arthritis (RA) is the relapsing-remitting clinical presentation of PR, as opposed to the generally persistent joint involvement in RA that does not remit unless treated.

Palindromic rheumatism is named after the term 'palindrome', which refers to a word or phrase that reads the same way forwards and backward, such as 'level' or 'madam'. During a typical palindromic attack, the symptoms begin and end in the same way, with the most severe point occurring in the middle.

Etiology

The exact cause of Palindromic Rheumatism (PR) is still unknown. However, research indicates that PR is linked to the development of autoimmune rheumatic diseases, particularly rheumatoid arthritis (RA). Studies have shown that after a varying follow-up period, approximately 15% to 66% of patients with PR went on to develop RA.

Several factors predict the progression of psoriatic arthritis (PR) to rheumatoid arthritis (RA), including genetic background, ultrasonographic findings of synovitis, the presence of anti-cyclic citrullinated peptide antibodies (ACPA), positive rheumatoid factor, and hand involvement. Conversely, some genetic backgrounds, like HLA-DRB1, may increase susceptibility to Palindromic Rheumatism(PR) but not RA, indicating that PR is distinct from RA.

Diagnosis

Palindromic rheumatism is diagnosed based on symptoms and a physical examination during an attack, as there are no specific tests for it. This approach helps to rule out other forms of arthritis. Taking an X-ray of the affected joints during an attack may also be helpful in confirming the diagnosis.Blood tests may also be helpful in providing support for the diagnosis and for ruling out other conditions.

The differential diagnosis of PR is quite extensive due to the various diseases that can cause an intermittent pattern of arthritis. Thus, short-lasting episodes characterize PR, differentiating it from other types of arthritis with intermittent courses.