Case Report

Palindromic Rheumatism

Authors: Veena R. Iyer, MD, George L. Cohen, MD

Abstract

We present the case of a 56-year-old woman with a one-month history of recurrent, migratory oligoarthritis. Laboratory tests were normal except for positive antinuclear antibody (ANA) titers. Imaging studies were normal. Palindromic rheumatism (PR) was considered as a diagnosis. In this brief report, we discuss the etiopathogenesis, clinical presentation, prognosis and treatment of this entity. We also elaborate on the factors associated with progression to chronic joint disease. It is important for the primary care physician to be aware of this relatively uncommon diagnosis in patients presenting with joint pains and to distinguish it from other causes of recurrent arthritis, especially rheumatoid arthritis (RA).


Key Points


* Palindromic rheumatism (PR) is characterized by recurrent attacks of arthritis which last for hours to days, and resolves completely with no articular damage.


* PR is characterized by the absence of fever and negative laboratory tests and radiographic tests. The typical clinical features can help to differentiate it from other causes of joint pain. It must be considered as a diagnosis of exclusion in patients with no positive laboratory or imaging tests.


* Prognosis with PR is varied; one-third of patients experience remission; one-third experience recurrence, and one-third progress to rheumatoid arthritis (RA).


* Nonsteroidal anti-inflammatory drugs (NSAIDs) are useful in control of acute attacks and anti-malarials help to prevent attacks and reduce their frequency and severity.

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