Palindromic Rheumatism - The Basics

Palindromic Rheumatism and Rheumatoid Arthritis - What's the Difference?

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Palindromic rheumatism is a rare type of inflammatory arthritis. Symptoms of palindromic rheumatism are often mistaken for rheumatoid arthritis (RA) symptoms. There are distinguishing features between the two conditions, however, and it is important to recognize the difference.

Palindromic Rheumatism - What You Should Know

  • As a rare type of inflammatory arthritis with distinctive features, palindromic rheumatism is sometimes referred to as a syndrome. A syndrome is defined as a collection of symptoms.
    • Palindromic rheumatism is characterized by episodes or attacks of pain and swelling of the joints, as well as tissues that surround the joints.
    • Attacks of palindromic rheumatism usually involve one to three joints.
    • Attacks of palindromic rheumatism start suddenly and last for hours or days before spontaneous remission occurs.
    • Attacks recur but with unpredictable frequency. Some doctors and patients have recognized that patterns begin to develop.
    • Palindromic rheumatism does not usually lead to permanent joint damage, unlike rheumatoid arthritis. This is one of the major differences between the two diseases.
    • Approximately 30-40 percent of people with palindromic rheumatism develop more frequent episodes or attacks over time. They may later develop rheumatoid arthritis and their rheumatoid factor may become positive.
    • The most commonly involved joints with palindromic rheumatism include the large joints, knees, and fingers.
      • Subcutaneous nodules may also develop in people who have palindromic rheumatism, but the nodules are different in some ways from those seen in rheumatoid arthritis.
        • X-rays are normal in people with palindromic rheumatism. With palindromic rheumatism, joint space narrowing and joint damage is not evident, unlike rheumatoid arthritis.
        • According to the Arthritis Foundation, while the cause of palindromic rheumatism is unknown, a possible allergic origin has been suggested.

        Prevalence of Palindromic Rheumatism

        Rare is a word commonly associated with palindromic rheumatism. To put it in perspective, there are about 1.5 million people with rheumatoid arthritis in the United States. Reportedly, between 105,000 and 262,500 people in the United States have palindromic rheumatism.

        Men and women are equally affected by palindromic rheumatism, another difference from rheumatoid arthritis which is more common among women. Palindromic rheumatism affects people from 20 years old to 70 years old.

        Treatment for Palindromic Rheumatism

        During attacks associated with palindromic rheumatism, nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed. Oral steroids or local steroid injections may also be included in the treatment plan. Disease-modifying anti-rheumatic drugs (DMARDs) and colchicine are sometimes prescribed to prevent future attacks of palindromic rheumatism.

        According to a study published in the January 2000 issue of the Journal of Rheumatology, the use of anti-malarial drugs (e.g., Plaquenil) in people with palindromic rheumatism has been associated with decreasing the risk of developing rheumatoid arthritis or other connective tissue diseases.

        Progression to Rheumatoid Arthritis

        According to UpToDate, "The proportion of patients presenting with palindromic rheumatism who progress to develop RA or another well-defined disease varies between studies. In one study of 60 patients with palindromic rheumatism followed over 20 years, 40 (67 percent) developed RA.

        In another study, among 147 such patients seen in a tertiary referral center, 41 were eventually diagnosed with RA (28 percent) and four with other disorders (three with systemic lupus erythematosus and one with Behçet’s syndrome)."

        It has been suggested that people who are positive for anti-CCP are more likely to progress from palindromic rheumatism to rheumatoid arthritis. This has not been fully confirmed with studies.

        Sources:

        Gonzalez-Lopez, Laura. Decreased Progression to Rheumatoid Arthritis or Other Connective Tissue Diseases in Patients with Palindromic Rheumatism Treated with Antimalarials. Journal of Rheumatology 27January 2000 41-6.

        Palindromic Rheumatism. Arthritis Foundation.

        Venables, PJW et al. Clinical manifestations of Rheumatoid Arthritis. Palindromic Rheumatism. Updated August 2, 2016.

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