Palindromic rheumatism

Palindromic rheumatism (PR) is a type of recurrent arthritis characterized by episodes or "attacks" of joint inflammation, sequentially affecting one to several joint areas for hours to days. A PR attack often occurs suddenly without any obvious triggers or warning symptoms. Any joint(s) may be affected, but finger joints, wrists, and knees are most commonly affected. Symptoms during episodes may include pain, swelling, stiffness, and redness in and around the joints. Some people may have a fever and other systemic symptoms. Between episodes, people with PR have no symptoms. The time between episodes may last from days to months.

The underlying cause of PR is not known. Some people with PR eventually develop chronic rheumatic disease, the most common being rheumatoid arthritis (RA). Others may develop lupus and/or other systemic disorders. People with anti-CCP antibodies detected in a blood test appear more likely to develop RA. There has been some evidence to support that PR can be a presenting feature of RA (or part of the spectrum of RA), rather than a distinct condition.

Treatment of PR is challenging, as it has not been studied in randomized trials. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to treat acute episodes. Disease-modifying antirheumatic drugs (DMARDs) may be an option for those with refractory, frequent attacks. Hydroxychloroquine (a DMARD) reportedly may help control attacks and reduce the risk of progression to RA.