Does Palindromic Rheumatism Show on X-Ray
While X-rays of the hands can be beneficial in diagnosing palindromic rheumatism, they have limited use early in the disease phase

Palindromic rheumatism cannot be identified with a specific test or imaging study. X-rays may appear normal, since the disease does not cause joint erosion. While X-rays of the hands can be beneficial in diagnosing palindromic rheumatism, they have limited use early in the disease phase.

How is palindromic rheumatism diagnosed?

Flares of palindromic rheumatism may last days or just a few hours, whereas symptom-free periods can span weeks or months. Because palindromic rheumatism symptoms fade between attacks, testing is best done during a flare. 

Diagnosis of palindromic rheumatism can be particularly difficult because many patients test positive for rheumatoid factor and anticitrullinated protein antibodies (anti-CCP), both of which are common in rheumatoid arthritis. Because of this, your doctor will prioritize a history of migratory arthritis when diagnosing palindromic rheumatism (different joints affected at different times). In certain cases, magnetic resonance imaging scans may reveal synovitis and bone edema.

Some doctors may follow palindromic rheumatism diagnostic criteria, which include:

  • History of short, sudden-onset, recurring incidents of monoarthritis or oligoarthritis
  • Direct observation of one attack by a physician
  • Three or more joints engaged in separate episodes
  • More than five attacks in the previous two years
  • Negative X-rays, acute phase reactants, and rheumatoid factors
  • Exclusion of other recurrent monoarthritis

What are symptoms of palindromic rheumatism?

Palindromic rheumatism is a rare inflammatory disease that can lead to rheumatoid arthritis in roughly one-third of patients characterized by palindromic (or repeating) joint pain and stiffness. This type of arthritis disappears and reappears from time to time.

Common symptoms of palindromic rheumatism include:

  • Sudden and recurring incidents of severe swelling in one or more joints, lasting many days or only a few hours
  • Fatigue 
  • General feeling of being unwell
  • Fever of moderate severity
  • Nodules beneath the skin near the affected joints
  • During the first flare-up, inflammatory activity may spread from joint to joint, but it quickly subsides, with joints feeling normal after a short time
  • Chronic joint inflammation may progress into rheumatoid arthritis
  • Joints may become hot and sensitive
  • Tendons and regions around the joint may become inflamed and painful
  • Skin above the joint may appear red and warm

What causes palindromic rheumatism?

Causes of palindromic rheumatism are autoimmune-related. Studies have shown that inflammatory cells travel into the joint lining during a flare, causing distinctive redness and swelling in the affected area. It is unclear what causes this response, although genetic factors may play a role.. 

Triggers and risk factors of palindromic rheumatism may include:

  • Infection (Whipple’s disease is caused by the pathogenic agent Tropheryma whipplei, which typically manifests as palindromic rheumatism)
  • Hormonal imbalance
  • Trauma
  • Genetic predisposition (several circumstances can activate certain genes and increase the likelihood of symptoms occurring.
  • Environmental factors (lifestyle, diet, and gastrointestinal health can influence the probability and severity of arthritis pain)

Due to the rarity of the condition, little research has been conducted on the subject. In patients with palindromic rheumatism, rheumatoid factor positivity could be a risk factor for the development of rheumatoid arthritis.

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How is palindromic rheumatism treated?

Palindromic rheumatism cannot be cured, but symptoms can be managed with treatment.

  • Nonsteroidal anti-inflammatory medications
    • Reduces pain, inflammation, and stiffness in the joint
  • Antimalarial drugs, disease-modifying antirheumatic drugs, and glucocorticoids
    • May reduce the frequency and duration of attacks.
    • May reduce the likelihood of getting rheumatoid arthritis in the future
    • While usually not the first choice of treatment, these may be an option if your doctor believes it is the best type of therapy for your specific case
    • When attacks are polyarticular or risk factors are present, the use of disease-modifying antirheumatic drugs should be considered
    • For those who have refractory, frequent attacks, disease-modifying antirheumatic drugs (DMARDs) may be an option
    • According to reports, hydroxychloroquine (a DMARD) may help control attacks and reduce the risk of progression to rheumatoid arthritis
    • Glucocorticoids have had some success during acute attacks

During a flare-up, symptoms can be managed with the following:

  • Wrist splints 
  • Shoes with insoles
  • Ice packs
  • Rest
  • Avoiding triggers

Lifestyle changes can also help with symptoms:

  • Diet: Eating a well-balanced diet and maintaining a healthy weight may help you avoid putting excess stress on your joints.
  • Exercise: Staying active helps keep your joints working properly, but it is important to know your limits and not overexert yourself, because palindromic rheumatism can cause fatigue. A physiotherapist can help you find the best balance of rest and exercise. If you are unable to work due to your condition, there could be programs that assist those with disabilities.
  • Supplements: Ask your doctor about nutrition supplements that may help mitigate symptoms of palindromic rheumatism during flare-ups

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Medically Reviewed on 6/20/2022
References
Image Source: iStock image

Versus Arthritis. Palindromic rheumatism. https://www.versusarthritis.org/about-arthritis/conditions/palindromic-rheumatism/#

Arthritis Foundation. Palindromic Rheumatism. https://www.arthritis.org/diseases/palindromic-rheumatism

Brown J. Understanding Palindromic Rheumatism: What Is It and How It Differs from RA. CreakyJoints. https://creakyjoints.org/diagnosis/what-is-palindromic-rheumatism/