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Palindromic Rheumatism - The Basics

Palindromic Rheumatism Often Confused With Rheumatoid Arthritis

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Updated September 05, 2012

What is Palindromic Rheumatism?

Palindromic rheumatism is a rare type of inflammatory arthritis. Symptoms are often mistaken for rheumatoid arthritis symptoms. There are distinguishing features between palindromic rheumatism and rheumatoid arthritis and it is important to recognize the difference.

Palindromic Rheumatism: What You Should Know

  • As a rare type of inflammatory arthritis with distinctive features, palindromic rheumatism is sometimes referred to as a syndrome. A syndrome is defined as a collection of symptoms.
  • Palindromic rheumatism is characterized by episodes or attacks of pain and swelling of the joints, as well as tissues that surround the joints.
  • Attacks of palindromic rheumatism usually involve one to three joints.
  • Attacks of palindromic rheumatism start suddenly and last for hours or days before spontaneous remission occurs.
  • Attacks recur but with unpredictable frequency. Some doctors and patients have recognized that patterns begin to develop.
  • Palindromic rheumatism does not usually lead to permanent joint damage, unlike rheumatoid arthritis. This is one of the major differences between the two diseases.
  • Approximately 30-40 percent of palindromic rheumatism patients develop more frequent episodes or attacks over time. They may later develop rheumatoid arthritis and their rheumatoid factor may become positive.
  • The most commonly involved joints with palindromic rheumatism include: large joints, knees, and fingers.
  • Subcutaneous nodules may also develop in palindromic rheumatism patients but the nodules are different in some ways from those seen in rheumatoid arthritis patients.
  • X-rays are normal in patients with palindromic rheumatism as joint space narrowing is not present as it is in rheumatoid arthritis.

Prevalence of Palindromic Rheumatism

Rare is a word commonly associated with palindromic rheumatism. To put it in perspective, there are 2.1 million people with rheumatoid arthritis in the United States. Reportedly, between 105,000 and 262,500 people in the United States have palindromic rheumatism.

Men and women are equally affected by palindromic rheumatism, another difference from rheumatoid arthritis which is more common among women. Palindromic rheumatism affects people from 20 years old to 70 years old.

Treatment for Palindromic Rheumatism

During attacks associated with palindromic rheumatism, nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed. Oral steroids or local steroid injections may also be included in the treatment plan. Disease-modifying anti-rheumatic drugs (DMARDs) and colchicine are sometimes prescribed to prevent future attacks of palindromic rheumatism.

The use of anti-malarial drugs (e.g. Plaquenil) in patients with palindromic rheumatism has been associated with decreased risk of developing rheumatoid arthritis or other connective tissue diseases, according to a study published in the January 2000 issue of the Journal of Rheumatology.

Sources:

Rheum Rounds: Palindromic Rheumatism. Lam M.D., Gordon. Johns Hopkins Arthritis Center. December 1, 2005.
http://www.hopkins-arthritis.org/rheumrounds/palindromic_rheumround1.html

Decreased Progression to Rheumatoid Arthritis or Other Connective Tissue Diseases in Patients with Palindromic Rheumatism Treated with Antimalarials. Gonzalez-Lopez, Laura. Journal of Rheumatology 27January 2000 41-6.
http://jrheum.com/abstracts/abstracts00/41.html

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