An x-ray image of a person's hands with red joints.
While any joint can be affected, palindromic rheumatism commonly develops in the hands and can lead to rheumatoid arthritis.

Palindromic Rheumatism

Palindromic rheumatism is a rare type of recurrent inflammatory arthritis that is characterized by episodes (commonly called attacks) of joint inflammation that last for hours to days. In between episodes, the affected joints go back to normal and there is no permanent damage. However, about half of people who suffer from palindromic rheumatism develop rheumatoid arthritis (RA) over time, which leads to permanent, often severe, damage to the joints of the body.

4 Common Symptoms of Palindromic Rheumatism

A palindromic rheumatism attack commonly starts suddenly without any obvious triggers or warning signs and may include the following symptoms:

1. Joint Pain, Swelling, Stiffness, Warmth or Redness

Any joint can be affected, but the joints of the hands are commonly involved. Areas around the affected joint, including the tendons, may also become swollen and painful. Affected joints often change from one attack to the next. Limited joint range of motion can also happen during the attack, and it usually returns to normal once the attack resolves itself.

Joint symptoms typically flare up in the evenings and spontaneously go away within a few hours to days. It’s good to know that there is no joint erosion.

2. Mild, Low-Grade Fever

If you have chills or hot flashes often, it is important to get a thermometer and check your temperature. If you have a fever, with your body measuring over 100F, this can often be a sign that something is wrong in your body, such as palindromic rheumatism. If this happens consistently, talk to your doctor so they can get to the root cause, giving you a proper treatment plan.

3. Fatigue

Some individuals feel extremely tired after having an attack. This tiredness can last for several days to weeks. It may affect both physical and mental functioning.

4. Nodules Under the Skin

Nodules may develop under the skin around the area of the affected joints.

Attacks may last from several hours to days, followed by spontaneous resolution of symptoms. The time between palindromic rheumatism attacks can be days to months, and during this time there are no symptoms, and the affected joints return to normal.

Causes of Palindromic Rheumatism

The underlying cause of palindromic rheumatism is not fully understood. However, it may be due to an inflammatory reaction that results when inflammatory cells move along the joint lining, leading to symptoms of joint swelling, redness, pain, stiffness, warmth or redness. It may involve various factors including trauma, family history and genetics, infections and allergic reactions.

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Management Options

Treatment of palindromic rheumatism is often difficult, and it has not been thoroughly studied in randomized trials. It’s best to be under the care of a rheumatologist to be monitored for the development of other conditions that may require different treatment, including rheumatoid arthritis.

Treatment for palindromic rheumatism may include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs), including naproxen and ibuprofen, to reduce joint inflammation, pain and stiffness during an acute attack.
  • Disease-modifying antirheumatic drugs (DMARDs), including sulfasalazine, hydroxychloroquine, methotrexate or leflunomide to treat frequent attacks and reduce the risk of disease progression to rheumatoid arthritis. When taking DMARDs, regular blood monitoring may be necessary to monitor side effects including issues with the liver, kidneys and/or blood count.
  • Steroid injections, which may be used in rare cases to treat extreme inflammation and severe pain.

In addition to traditional medical management of palindromic rheumatism, making lifestyle changes can help to manage symptoms. Simple lifestyle changes include:

  • Regular aerobic exercise to keep joints moving and healthy.
  • Stretching to improve range of motion and flexibility.
  • Strength-training exercises to maintain and improve muscle strength around the affected joints.
  • Maintaining a healthy weight to help to manage symptoms as being overweight puts excess stress on joints and can worsen symptoms of an attack.
  • Eating a healthy, balanced, diet that includes a lot of fruit and vegetables, as it is recommended for general health.

Diagnosis Process

Diagnosis of palindromic rheumatism is challenging as there is no specific test that identifies this condition. Physicians rely on a detailed medical history, including a history of migratory arthritis (different joints being affected from one attack to the next), thorough physical examination, as well as blood and imaging tests to make a diagnosis of palindromic rheumatism.

Blood tests may include the following:

  • Erythrocyte sedimentation rate (ESR).
  • C-reactive protein.
  • Rheumatoid factor.
  • Anti-CCP antibodies anti-nuclear antibodies.

Imaging tests, including x-rays, may be recommended to rule out other conditions.

In order to obtain a diagnosis, it is best to undergo any testing during an attack, as symptoms of palindromic rheumatism go away between attacks.

In Conclusion

Palindromic arthritis is a rare type of inflammatory arthritis that causes bouts of joint inflammation resulting in a variety of uncomfortable symptoms. Diagnosis and treatment of palindromic rheumatism is often difficult as research is limited on this condition. While palindromic rheumatism doesn’t leave any lasting joint damage, approximately half of patients go on to develop rheumatoid arthritis, which can cause permanent, and often severe, joint damage. It’s therefore important to discuss any worrying joint symptoms with your doctor.