Palindromic Rheumatism

Arthritis characterized by recurring and relatively brief periods of pain and swelling in one or more joints. Typically, symptoms of palindromic rheumatism last from a few hours to a few days and then go away entirely until the next episode.

The term “palindromic rheumatism” was coined in 1944 by doctors at the Mayo Clinic in Rochester, Minnesota, who reported on 34 people with the condition. Many of us know palindromes as phrases that read the same forward as backwards — a well-known example is “Able was I ere I saw Elba” — but “palindromic” is actually Greek for “returning.” The main symptom of palindromic rheumatism is joint swelling, which can cause severe pain. Palindromic rheumatism usually begins in a single joint but may affect several joints in the course of an episode. The joints most commonly affected are the knuckles and middle joints of the fingers, the wrists, the knees, the shoulders, the ankles, the feet, and the elbows. Small nodules may also appear, typically in the hands, wrists, elbows, or knees, and then go away when the swelling recedes. Episodes of palindromic rheumatism occur at irregular intervals, and between episodes people often feel no symptoms of the condition.

Palindromic rheumatism is rare. It has been estimated that the condition affects anywhere from 75,000 to 190,000 people in the United States. It can affect adults of any age and is equally common in women and men. During attacks, the blood of people with palindromic rheumatism often has an elevated erythrocyte sedimentation rate, a sign of inflammation. People with palindromic rheumatism are also more likely to test positive for rheumatoid factor and anti-CCP antibodies in their blood, both of which are markers of RA. It is estimated that one-third to one-half of people with palindromic rheumatism go on to develop full-blown RA.

Treatments for palindromic rheumatism have not been exhaustively studied. Drugs typically used for RA, including disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine (Azulfidine), are sometimes used, as are nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB). There are also reports that antimalarial drugs — the most commonly used for RA is hydroxychloroquine (Plaquenil) — and injectable gold are effective in treating the condition.

Robert S. Dinsmoor is a medical writer and editor based in Massachusetts.

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