Palindromic rheumatism (PR) is a rare episodic form of inflammatory arthritis – meaning the joint pain and swelling come and go. Between attacks, the symptoms disappear and the affected joints go back to normal, with no lasting damage. Half of the people who have palindromic rheumatism eventually develop rheumatoid arthritis, which does cause permanent joint damage. Palindromic rheumatism affects men and women equally, and typically affects people between the ages of 20 and 50.
The cause of palindromic rheumatism is unknown, although a possible allergic origin has been suggested.
Palindromic rheumatism is characterized by sudden, multiple, and recurring attacks of joint pain and swelling. Each episode may last from several hours to several days. The frequency of attacks varies, from one episode a day to several during the course of a year. Usually two or three joints are involved, but different joints may be involved in different episodes. The soft tissues around the joints may also be affected. Episodes of recurrence form a pattern, with symptom-free periods between attacks lasting for weeks to months. The joint usually returns back to normal without any permanent joint damage.
Some individuals with this condition develop chronic joint inflammation and go on to develop rheumatoid arthritis.
The doctor may diagnose this condition after a complete medical history, physical examination, and possibly X-rays. Laboratory tests may be ordered to rule out rheumatoid arthritis. No one test can diagnose palindromic rheumatism.
Treatment may include nonsteroidal anti-inflammatory drugs (NSAIDs) for acute attacks. Antimalarials, such as hydroxychloroquine, have been helpful in reducing the frequency and duration of attacks and may reduce the likelihood that palindromic rheumatism will progress to rheumatoid arthritis.
Managing flares of palindromic rheumatism requires balancing activity and rest, eating a nutritious diet, and following the recommended treatment plan. Self management involves making lifestyle choices and addressing both the physical and emotional effects of arthritis. It encompasses the choices made each day to live well and stay healthy.