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
- 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
- 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.
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
- 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
- CDC Warns of Potentially Fatal Bacterial Illness on U.S. Gulf Coast
- Helping Others as Volunteers Helps Kids 'Flourish': Study
- FDA Approves Pfizer's RSV Shot for Older Adults
- What to Do When Tough-to-Treat Lymphoma Strikes During Pregnancy
- Rate of Pregnant U.S. Women Who Have Diabetes Keeps Rising
- More Health News »
Health Solutions From Our Sponsors
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/
Top Does Palindromic Rheumatism Show on X-Ray Related Articles
acetaminophenAcetaminophen is a drug that reduces fever and relieves pain. It is available alone, or in combination with hundreds of other drugs available both over-the-counter (without a prescription) or that that may require a prescription from your doctor, for example, acetaminophen and hydrocodone (Vicodin, Norco) or acetaminophen and oxycodone (Percocet). Acetaminophen treats a variety of diseases or other medical problems that cause pain or fever. Examples of conditions acetaminophen treats include headache, minor arthritis pain, back pain, tooth pain, menstrual cramps, PMS, osteoarthritis, common cold, tension headache, chronic pain, hip pain, shoulder and neck pain, sore throat, sinus infection, teething, TMJ, bites and stings, and sprains and strains. Acetaminophen generally has no side effects when taken as prescribed. When side effects are experienced, the most common are headache, rash, and nausea.
Arthritis (Joint Inflammation)Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of arthritis, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and gout.
Arthritis: Everyday Habits to Ease InflammationChronic inflammation harms your body and raises risk of disease. These everyday lifestyle changes can help lower it.
Arthritis: 16 Bad Habits That Cause Joint PainBeing overweight, wearing uncomfortable shoes, or carrying a heavy purse can make joint pain and arthritis symptoms worse. Some bad habits increase inflammation and put you at risk of osteoarthritis and rheumatoid arthritis. Protect joints and muscles and prevent swelling and joint disorders by eliminating these joint problem bad habits.
Physical and Occupational Therapy for ArthritisPhysical therapy can help a patient with arthritis to work out stiffness without damaging their joints. Occupational therapy teaches the patient how to reduce joint strain during daily activities. Those receiving occupational or physical therapy will learn about their arthritis, be given a dietary plan if they are overweight, get foot care advice, and learn methods of relieving discomfort.
Arthritis: Supplements for Joint PainCan supplements help relieve joint pain and swelling? Find out how certain compounds may aid your stiff, tender joints.
Does Hand Grip Help With Arthritis?Because your hands are engaged in multiple functions every day, hand strength is a powerful predictor of your overall capacity to function and how severe your arthritis is.
How Serious Is Rheumatoid Arthritis?Rheumatoid arthritis (RA) is a chronic inflammatory disorder that typically affects the joints and other body parts. If not diagnosed early and appropriately treated, RA can lead to permanent deformities, disabilities, and serious systemic complications.
iodixanolIodixanol is a nonionic, iso-osmolar, water-soluble contrast agent used for X-ray (radiographic) imaging of the various arteries and veins. Common side effects of iodixanol include injection site reactions, chest pain, swelling from fluid retention (edema), nausea, vomiting, diarrhea, taste perversion (dysgeusia), blind spot in the visual field (scotoma), distortion of the sense of smell (parosmia), headache, and others. Consult your doctor if pregnant or breastfeeding.
iohexolIohexol is a nonionic water-soluble contrast agent used for X-ray (radiographic) imaging. Iohexol may be administered orally or as an injection depending on the type of radiologic procedure required. Common side effects of iohexol include headache, nerve pain (neuralgia), nausea, vomiting, backache, neck ache, stiffness, skin reactions, allergic reactions, and others.
OA & Your JointsDealing with joint pain and arthritis? Learn why weight matters--and why NOT to stretch before exercise. See these solutions for joint pain and tips to protect your joints from damage.
What Are the 3 Common Types of Arthritis?The 3 most common types of arthritis include osteoarthritis, rheumatoid arthritis, and gout.
What Is the Best Treatment for Arthritis?Arthritis refers to the inflammation of the joints. It presents as pain and swelling of the joints in the body. Painkillers, along with physical therapy, is usually considered the best treatment for arthritis in the early stages. Natural remedies and medications may also be used to treat arthritis, while surgery for arthritis is an option when a patient can't resume normal activities.
Which Foods Make Arthritis Worse?Foods that may worsen arthritis include processed foods, salt, red meat, and alcohol. Check out the center below for more medical references on arthritis, including multimedia (slideshows, images, and quizzes), related disease conditions, treatment and diagnosis, medications, and prevention or wellness.