What Is Palindromic Rheumatism?

Palindromic rheumatism (PR) is a rare type of inflammatory arthritis that causes symptoms to flare up sporadically and resolve without causing any lasting damage to joints. Symptoms that arise during palindromic rheumatism episodes—including joint pain and inflammation—are similar to those of rheumatoid arthritis (RA), but they differ in that they occur without warning and can last hours or a few days.

About half of people with palindromic rheumatism will go on to develop RA.

Symptoms of Palindromic Rheumatism

Palindromic rheumatism is characterized by painful attacks of the joints and surrounding tissue. Resulting symptoms, which are common to some other forms of arthritis, include:

• Pain
• Swelling
• Stiffness
• Redness in and around the joints

The large joints, knees, and fingers are most commonly affected in palindromic rheumatism and may or may not be accompanied by fever or other systemic symptoms. PR has a distinct pattern of symptoms that distinguish it from other types of joint pain. Typical episodes:

• Involve one to three joints
• Start suddenly and last hours or days before spontaneous remission occurs
• Recur with unpredictable frequency, though some people can recognize patterns and identify triggers

Between episodes, people with palindromic rheumatism are symptom-free and can go for days or months between attacks.

Causes

Palindromic rheumatism is considered an overlap syndrome. It has characteristics of both autoimmune and autoinflammatory diseases, but the underlying cause is unknown.

It is, however, considered to be on the rheumatoid arthritis continuum and may elevate your risk of eventually developing RA. Some researchers believe it's simply a very early stage of RA.

Palindromic rheumatism affects men and women equally and typically starts between the ages of 20 and 50. Some researchers suspect that episodes are caused by an allergic reaction, though there is a lack of convincing evidence to support this theory.

Diagnosis

The is no one test that definitively diagnoses palindromic rheumatism. It is diagnosed based on symptoms and the ruling out of other conditions.

Your healthcare provider will start by taking a complete medical history including details of your symptoms and how often they occur.

Lab tests may include blood work and urinalysis including:

• Rheumatoid factor
• Anti-cyclic citrullinated peptide (anti-CCP)
• C-reactive protein
• Sedimentation rate

Most people with palindromic rheumatism have some RA-related antibodies, which may show up on some of these tests.

Your healthcare provider may also take X-rays and ultrasound imaging to differentiate between types of joint inflammation. In PR, X-rays will be normal—i.e., without evidence of joint space narrowing or joint damage, which are common in RA.

Ultrasound assessment will commonly show non-synovial extracapsular inflammation without synovitis (inflammation of synovial tissue).

Treatment

During attacks of palindromic rheumatism, your healthcare provider may suggest prescription nonsteroidal anti-inflammatory drugs (NSAIDs) to help with pain and inflammation. Oral steroids or local steroid injections may also be included in the treatment plan for flares.

On-going treatment, taken daily to prevent future attacks, may involve disease-modifying anti-rheumatic drugs (DMARDs). Plaquenil (hydroxychloroquine) is the most common DMARD for palindromic rheumatism. Stronger drugs like methotrexate and sulfasalazine, which are frequently taken for other forms of arthritis, may also be options.

Self-Care

You can take added steps to help manage your symptoms during a flare, including:

• Resting painful joints
• Applying ice or heat
• Pacing yourself

It's unknown whether your diet plays any role in palindromic rheumatism, but an anti-inflammatory diet is sometimes recommended.

Prognosis

Palindromic rheumatism can take a few different disease paths. In some people, symptoms resolve without additional episodes, while others continue to have sporadic flare-ups.

For many, though, PR is a prodromic syndrome that leads to other rheumatoid conditions.

A review of data from multiple studies on palindromic rheumatism showed various outcomes for people with the condition, including:

• 15% entered prolonged remission (no attacks)
• 48% continued to have palindromic rheumatism with no progression to other disease
• 37% progressed to RA, other forms of arthritis, or other chronic conditions including lupus, granulomatosis with polyangiitis, Sjögren's syndrome, Behçet’s disease, and polymyalgia rheumatica

People with palindromic rheumatism who test positive for anti-CCP or rheumatoid factor are more likely to progress to RA. However, having these markers does not guarantee the disease will progress. When it does, the average time from first PR episode to RA diagnosis is 1.2 years.

A Word From Verywell

Living with palindromic rheumatism can be unpredictable. You can take control by:

• Working with your healthcare provider to develop an action plan for treating episodes
• Exploring treatment options to prevent episodes and reduce your risk of PR progressing to RA
• Practicing self-care to maintain good health between flares