Medicines for Palindromic rheumatism

What it is

Palindromic rheumatism is an unusual form of inflammatory joint condition characterised by sudden attacks of pain, swelling, warmth and stiffness in one or more joints, which come on quickly (often over hours), last from hours to a few days, and then settle completely, leaving the joints normal between attacks — the word "palindromic" reflects this coming-and-going pattern. The attacks can affect various joints (such as the fingers, wrists, knees and others), sometimes different joints at different times, and the tissues around the joints can be involved too. Between attacks, there is typically no swelling, no ongoing symptoms, and, importantly, palindromic rheumatism itself does not cause the permanent joint damage seen in some forms of arthritis. However, its significance is that in a proportion of people it can, over time, evolve into a persistent inflammatory arthritis — most commonly rheumatoid arthritis — so people with palindromic rheumatism are monitored for this. The cause is not fully understood, but it is thought to be related to the same kind of immune processes involved in rheumatoid arthritis. Because attacks are unpredictable and can be painful, and because of the potential to progress, it is assessed and managed.

How it is treated

Palindromic rheumatism is assessed by a doctor, often a rheumatologist, including blood tests (which may show markers associated with rheumatoid arthritis, helping to judge the risk of progression) and assessment of the joints, and other conditions are considered. Management has two aims: controlling the attacks, and monitoring for progression to a persistent arthritis. For the attacks, anti-inflammatory medicines (where suitable) help relieve the pain and swelling, and treating flares promptly is useful; for frequent or troublesome attacks, medicines used in rheumatoid arthritis (disease-modifying medicines, such as hydroxychloroquine) are sometimes used, which can reduce the frequency of attacks and may also lower the chance of it developing into a persistent arthritis. Regular follow-up monitors whether the pattern is changing towards a more constant arthritis, so that, if it does, treatment can be started early to protect the joints. Reassurance that palindromic rheumatism itself does not damage the joints, combined with awareness of the need for monitoring, is helpful. The reassuring message is that palindromic rheumatism causes attacks that fully settle without joint damage in themselves, that attacks can be controlled, and that monitoring allows early treatment if it starts to evolve into a persistent arthritis.