What Joints Does Palindromic Rheumatism Affect?

Palindromic rheumatism is a type of arthritis marked by flare-ups of joint pain and swelling that do not cause long-term joint damage. Palindromic rheumatism may linger for several days and migrate from joint to joint. These recurring episodes appear and disappear abruptly, and they frequently establish a pattern:

• Duration: Episodes may last anywhere from a few hours to a few days.
• Frequency: Episodes may occur every day or only a few times a year.
• Location: Two or three joints may be affected at the same time during an episode. They may affect the soft tissue around the joints.

Common signs and symptoms of palindromic rheumatism include:

• Fatigue
• Joint pain and inflammation
• Nodules under the skin near affected joints
• Painful and swollen tendons
• Red, warm skin over the affected joints
• General feeling of being unwell
• Mild fever

Palindromic rheumatism is rare, and little is known about what causes the condition. During attacks, inflammatory cells enter the lining of the joint, causing redness and swelling in the afflicted region.

Possible triggers and risk factors of palindromic rheumatism include:

• Infection
• Hormonal imbalance
• Trauma, accident, surgery of large joints
• Age (typically affects people aged 20-50)
• Family history (genetic factors)

There is no specific test that can confirm a diagnosis of palindromic rheumatism. Because anticyclic citrullinated peptide antibodies and antikeratin antibodies are found in a high number of patients, it has been suggested that palindromic rheumatism may be an abortive type of rheumatoid arthritis.

Palindromic rheumatism must be differentiated from acute gouty arthritis and rheumatoid arthritis with an unusual, acute onset. However, it can be difficult to identify palindromic rheumatism from other episodic joint issues without appropriate diagnostics (such as joint fluid analysis) since results of laboratory tests are typically normal. 

Blood tests may reveal an increase in erythrocyte sedimentation rate and C-reactive protein but are usually otherwise normal. Rheumatoid factors may be present, especially in those who are predisposed to developing rheumatoid arthritis.

There is currently no cure for palindromic rheumatism, but medications and lifestyle adjustments can help alleviate symptoms, reduce the intensity of episodes, and improve overall quality of life.

Lifestyle changes

• Regular exercise is critical to maintaining joint health. Rheumatism can limit mobility and make movement painful. Inactivity, however, can cause the surrounding muscles to break down and cause more damage to the joint itself.
• Stretches that enhance flexibility, range of motion, and muscular strength around the afflicted joints may reduce the intensity of attacks by allowing the joints to move more readily and provide greater support. Consult a doctor or physical therapist before beginning an exercise program to ensure that the intensity is appropriate and that no undue strain is placed on the afflicted joints.
• Maintaining a healthy weight might help reduce symptoms. Being overweight can place additional strain on the joints.
• Eating a healthy diet may be beneficial. Bitter gourd juice, celery juice, lemon juice, raw potato juice, and walnuts have shown in studies to soothe pain and reduce some symptoms in a patient with palindromic rheumatism.

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs): May control inflammation and reduce discomfort and joint stiffness.
• Disease-modifying anti-rheumatic drugs (DMARDs): Can be prescribed to reduce the frequency and severity of attacks often when inflammation is severe and long-lasting (DMARDS are immunosuppressants, however which means they can make you more susceptible to viral and bacterial infections).
• Steroid injections: May be recommended in rare cases if the joint or tendon has become severely inflamed and is causing substantial pain.

There are no serious complications linked to palindromic rheumatism. However, the condition can progress to rheumatoid arthritis in some cases, which can cause lifelong joint damage.

Studies have shown that the outlook for palindromic arthritis is as follows:

• About 10%-15% see their symptoms disappear
• About 30%-50% have only occasional attacks
• Between 30%-40% experience worsening symptoms