Palindromic rheumatism is a chronic disease manifested by repeated short—term attacks of migrating transient arthritis of one or more joints without disturbing the general condition of the patient. Both large joints and joints of the feet and hands can undergo inflammatory changes. Diagnosis is based on typical clinical signs and features of the course of the disease, as well as on the absence of significant changes in laboratory data, ultrasound and radiography of joints. Treatment is carried out with nonsteroidal anti-inflammatory drugs, colchicine, penicillamine, gold preparations. However, in most cases, during therapy, it is not possible to completely prevent the appearance of new attacks of this pathology.
ICD 10
M12.3 Palindromic rheumatism
Meaning
Palindromic rheumatism was described in rheumatology in 1944. The term “palindromic” introduced by the authors means “running back” in Greek, which emphasizes the constantly recurring nature of the disease. The name “rheumatism” was given to the disease due to the similarity of its clinical picture with rheumatism (subcutaneous nodules, involvement of periarticular tissues in the process). A number of authors still attribute palindromic rheumatism to a special variant of the onset of rheumatoid arthritis. This is due to the fact that over time, about a third of patients with palindromic rheumatism develop rheumatoid arthritis. Other systemic diseases may also develop: Sjogren’s disease, systemic lupus erythematosus, Whipple’s disease.
Causes
The factors provoking the occurrence are still unknown. Careful questioning of patients and the collection of anamnesis do not reveal the connection of the onset of the disease with any infectious, traumatic or other factor. It is only known that this pathology is based on a transient nonspecific inflammatory process that develops in the periarticular tissues and synovial membrane.
Symptoms
Typically, a sudden and acute onset of this disease, which is most often noted in the afternoon. Rapidly progressive inflammatory symptoms appear: redness, swelling, an increase in local temperature and soreness of the affected joint. These signs increase within a few hours and reach their maximum severity. Pain syndrome in various patients with palindromic rheumatism varies from mild to intense and painful. At the height of the attack, there may be some restriction of mobility in the joint associated with its swelling and soreness.
During the attack of this pathology, along with the symptoms of arthritis, inflammatory changes of periarticular tissues are noted: soreness and swelling of tendons in the places of their attachment to the joint, dense swelling in the area of muscles suitable to the joint, swelling of the pads of fingers and heels. In 1/3 of cases of palindromic rheumatism, the appearance of subcutaneous rheumatic nodules of small size is observed. They are located along the tendons on the hands and feet, in the area of palmar aponeurosis and on the extensor surface of the forearms.
The attack of this disease, as a rule, proceeds with the involvement of one, less often — two joints. The greatest number of cases occur in the defeat of the knee joint. Inflammatory changes of the shoulder, wrist, ankle, metacarpal, proximal interphalangeal, temporomandibular joints, foot joints, as well as the cervical spine are possible. A distinctive feature of palindromic rheumatism is the migration of inflammation from one joint to another with each new attack.
An attack of palindromic rheumatism can last several hours, usually no more than 2-3 days. The maximum duration of the attack observed in individual clinical cases was 7 days. The period between attacks of palindromic rheumatism can take from several days to 2-3 months. It is characterized by the absence during an attack of palindromic rheumatism of general clinical manifestations, such as fever, malaise, chills, etc. The appearance of general symptoms, morning stiffness of the affected joint and/or repeated inflammation of the same joint during subsequent attacks indicates the transformation of palindromic rheumatism into rheumatoid arthritis.
Diagnostics
When making a diagnosis of palindromic rheumatism, a rheumatologist primarily relies on the typical clinical picture of the disease with the sudden onset and rapid resolution of seizures, migration of the lesion from one joint to another and the absence of any manifestations in the period between attacks. Clinical studies of blood and synovial fluid, examinations of the affected joint do not provide specific data. On the other hand, the very absence of pathological changes in them indicates in favor of the diagnosis of palindromic rheumatism.
During the attack period of palindromic rheumatism, a moderate increase in ESR is possible in the blood test, the detection of a low RF titer. Acceleration of ESR persisting in the period between attacks may be a sign of the development of rheumatoid arthritis. Biopsy of the synovial membrane of the affected joint during the attack of palindromic rheumatism reveals nonspecific inflammatory changes.
During radiography and ultrasound of the joints in patients with palindromic rheumatism, no pathological abnormalities are detected. In some cases, the X-ray shows an increase in the shadow of the periarticular tissues, due to their pronounced swelling during the attack.
Differential diagnosis of palindromic rheumatism should be carried out with rheumatoid arthritis, gout attack, hydroxyapatite arthropathy, intermittent hydrarthrosis, seronegative spondyloarthritis.
Treatment
Therapy of patients during the attack of palindromic rheumatism is carried out with nonsteroidal anti-inflammatory drugs (ibuprofen, diclofenac, nimesulide, etc.). They effectively alleviate the acute symptoms of the disease, but do not prevent the emergence of new attacks. Injections of gold salts, penicillamine, sulfasalazine, colchicine, antimalarial drugs are also used in the treatment of this disease.
Forecast
Treatment of palindromic rheumatism in most cases does not lead to a complete recovery of patients. However, even with a long course of the disease, patients remain able to work. It can be briefly disrupted only during the period of a pronounced attack of the disease. The development of joint deformities and disability of patients with palindromic rheumatism does not occur.