Palindromic rheumatism

Palindromic rheumatism is a rare form of inflammatory arthritis characterized by repetitive, afebrile episodes of acute arthritis and peri-arthritis. Palindromic rheumatism typically presents with the following features:

Recurrent, sudden-onset attacks of arthritis involving one or multiple joints. Periarticular inflammation with swelling, tenderness, and warmth. Episodes are typically brief, lasting hours to days, and resolve spontaneously.

Diagnosing palindromic rheumatism involves clinical evaluation and exclusion of other causes of acute arthritis.

Diagnostic criteria include recurrent, self-limited episodes of arthritis for less than 72 hours with spontaneous resolution. Absence of radiographic evidence of joint damage during intercritical periods. Negative rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Exclusion of other rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, and gout.

Basic treatment aims to relieve symptoms and prevent disease progression may include: Nonsteroidal anti-inflammatory drugs for pain relief and inflammation control during acute episodes. Intra-articular corticosteroid injections for localized joint inflammation.
Disease-modifying anti-rheumatic drugs (DMARDs) such as hydroxychloroquine to reduce disease activity and prevent joint damage.

Advanced treatment options are reserved for patients with severe or refractory disease and may include:

Methotrexate or other conventional DMARDs for patients who do not respond adequately to initial therapy or biologic agents targeting specific inflammatory pathways, such as tumor necrosis factor (TNF).

Regular follow-up visits with a rheumatologist are important for monitoring disease activity, adjusting treatment as needed, and addressing any new symptoms or concerns. Periodic assessments of joint function, inflammatory markers, and imaging studies help track disease progression and treatment response.

The prognosis of palindromic rheumatism varies widely among individuals. Some patients experience spontaneous remission of symptoms, while others may progress to chronic inflammatory arthritis such as rheumatoid arthritis over time. Early diagnosis and prompt initiation of appropriate treatment can help prevent joint damage and improve long-term outcomes.