by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Palindromic arthritis – better known as palindromic rheumatism- (PR) is a condition where there are recurrent sporadic episodes of pain swelling warmth and stiffness of joints.
The problem usually involves 2 or 3 joints, with an onset developing over a few hours. PR is characterized by episodic pain in and around joints, often accompanied by redness. The pain may be intense but rarely lasts longer than 2 or 3 days and resolves totally afterwards with no residual effects. 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.
PR patients share many features with rheumatoid arthritis that indicate that it may be a subset of rheumatoid arthritis. The presence of anti-CCP antibodies in patients with PR has been noted by a number of researchers. It's probable that these patients had a palindromic presentation of rheumatoid arthritis.
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.
The patient may or may not have a fever.
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 anti-inflammatory medicines are not particularly effective. The use of disease-modifying drugs such as hydroxyxhloroquine or methotrexate is advised for patients with debilitating attacks, particularly if the patients are rheumatoid factor or anti-CCP positive. In fact, with this combination of symptoms and objective test results, I usually treat the patient as if they have RA... which, in all likelihood, they have.
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