Palindromic Rheumatism by drdoc on-line
 

Palindromic Rheumatism describes a syndrome where there are recurrent episodes of pain swelling warmth and stiffness of joints.

The problem usually involves 2 or 3 joints, which have onset over hours and last days - weeks, before subsiding. However episodes of recurrence form a pattern, with symptom free periods between attacks lasting for weeks to months.

In 30-40 percent however they become more frequent and may develop into Rheumatoid arthritis. Similarly, Rheumatoid factor can become positive over years.
The large joints are most commonly involved.
The soft tissues - are also involved with the swelling of the periarticular tissues, especially heel pads and the finger pads.
Nodules may be found in the subcutaneous tissues.

Constitutionally, the patient may or may not have a fever, and swelling of the joints.

Blood tests may show an elevation of the ESR and CRP, but are otherwise unremarkable.
Rheumatoid factor may be present especially in the group that is likely to develop Rheumatoid arthritis.

The therapy is difficult as the episodes are transient and antiinflammatories are not very helpful.
The episodes however have been reduced by several second line agents - especially Intramuscular gold, or colchicine.
Penicillamine and antimalarials have been used in some trials.

 

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Dr David Gotlieb
MBChB FCP(SA)
Cape Town
South Africa
Nov. 1996

Revised Oct 2001