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palindromic rheumatism
ICD-10 Codes
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Description
Palindromic Rheumatism: A Rare Autoimmune Form of Arthritis
Palindromic rheumatism (PR) is a rare autoimmune form of arthritis that causes flares of inflammation and stiffness, but does not cause lasting damage to the joints [3]. It is characterized by episodes or "attacks" of joint inflammation, sequentially affecting one to several joint areas for hours to days [4].
Symptoms
During an attack of palindromic rheumatism, the joints involved – and the tendons and area around them – will feel painful and stiff, and may look swollen [1]. The symptoms can vary in duration and frequency from person to person, but typically last for several hours to days [11].
Key Features
- Episodes of joint inflammation that come and go
- No lasting damage to joints
- Symptoms similar to rheumatoid arthritis (RA), but without warning and resolving on their own
- Can affect any joint, but finger joints, wrists, and knees are commonly involved
Unique Aspects
Palindromic rheumatism is named after the term 'palindrome', which refers to a word or phrase that reads the same way forwards and backward [5]. This name reflects the characteristic pattern of symptoms that can go back and forth from one joint to another, with the most severe point occurring in the middle.
References
[1] Context 1 [3] Context 3 [4] Context 4 [5] Context 5
Signs and Symptoms
Palindromic Rheumatism: Signs and Symptoms
Palindromic rheumatism (PR) is a rare type of inflammatory arthritis characterized by episodes or "attacks" of joint inflammation, sequentially affecting one to several joint areas for hours to days. The symptoms of PR can vary from person to person but typically include:
- Sudden and recurrent attacks of inflammation: These attacks can occur without any obvious triggers or warning symptoms [8].
- Joint pain and stiffness: During an attack, the joints involved – and the tendons and area around them – will feel painful and stiff [1].
- Tenderness and swelling: The affected joints may appear swollen and tender to the touch during an episode of PR.
- Episodes can last from hours to days: Symptoms can resolve without causing any lasting damage to the joints, but some people may experience recurring episodes [6].
It's essential to note that PR symptoms are similar to those of rheumatoid arthritis (RA), but they differ in that they occur without warning and can last for only a short period. If you're experiencing these symptoms, it's crucial to consult with a healthcare professional for proper diagnosis and treatment.
References:
- [1] Context result 8
- [6] Context result 6
- [8] Context result 8
Additional Symptoms
- Tenderness and swelling
- Sudden and recurrent attacks of inflammation
- Episodes can last from hours to days
- joint pain
Diagnostic Tests
Diagnostic Tests for Palindromic Rheumatism
Palindromic rheumatism (PR) is a rare autoimmune form of arthritis that causes flares of inflammation and stiffness, but it cannot be diagnosed through one specific test. A diagnosis will be based on your symptoms, as well as blood tests and scans.
- Blood Tests: Blood tests for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can be used to help diagnose PR, as these show levels of inflammation in the body [7][9].
- Physical Exams: A doctor will ask questions and look at your joints to help rule out other forms of inflammatory arthritis. Ideally, a doctor should examine you during an attack, before your symptoms disappear [2].
- Imaging Tests: X-rays of the hands can be useful in identifying PR, but they are not specific for this condition [4].
- Rheumatoid Factor and Anti-CCP Tests: Many patients with PR test positive for rheumatoid factor and anti-citrullinated protein antibodies (anti-CCP), which are commonly positive in those with rheumatoid arthritis. However, having these markers does not guarantee the disease will progress [11].
- Clinical Presentation: A diagnosis of PR is clinical, based on a presentation of very short-lasting joint attacks with a relapsing/ remitting course [8].
It's worth noting that no single test can confirm a diagnosis of palindromic rheumatism. A doctor may make a diagnosis based on medical history and signs and symptoms, and must distinguish PR from acute gouty arthritis and an atypical, acute onset of rheumatoid arthritis [13].
Treatment
Treatment Options for Palindromic Rheumatism
Palindromic rheumatism, a rare condition characterized by sudden and recurring joint inflammation, can be effectively managed with various drug treatments. The primary goal of treatment is to reduce pain and inflammation during flare-ups.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are the most commonly used medications for treating palindromic rheumatism flares. NSAIDs help reduce inflammation and alleviate pain, making them an essential part of managing this condition.
- [2] Medication is a main treatment for Palindromic Rheumatism flares, with drugs to reduce pain and inflammation being the primary focus.
- [6] Research has shown that antibiotic medications, often used to treat malaria, can also reduce the duration of PR attacks and lower the likelihood of progression to RA.
- Anti-malarial Drugs: These medications, such as hydroxychloroquine (Plaquenil), have been found to be effective in reducing the frequency and severity of palindromic rheumatism flares. They may also help prevent the condition from progressing to rheumatoid arthritis.
- [4] The use of DMARDs, including anti-malarial drugs like hydroxychloroquine, has been shown to lower the number and length of attacks in PR.
- Iguratimod (IGU): This medication has been studied as a potential treatment for palindromic rheumatism. Research suggests that IGU may be effective in reducing flare frequency and improving patient outcomes.
- [5] A study involving 40 patients with PR found that IGU reduced the number of flares and improved patient VAS scores.
Other Treatment Options
While NSAIDs, anti-malarial drugs, and iguratimod are the primary treatments for palindromic rheumatism, other medications may also be used to manage symptoms. These include:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): In addition to being used to treat flares, NSAIDs can help reduce inflammation and alleviate pain.
- [7] The main treatments for palindromic rheumatism are drugs to treat the pain, drugs to reduce inflammation, and drugs to treat the condition itself.
- Other Medications: Depending on individual patient needs, other medications may be prescribed to manage symptoms or prevent flares.
Important Consideration
It's essential to work closely with healthcare providers to find the best treatment plan for each individual. People respond differently to treatments, so a tailored approach is often necessary to effectively manage palindromic rheumatism.
References: [2], [4], [5], [6], [7]
Differential Diagnosis
Differential Diagnosis of Palindromic Rheumatism
Palindromic rheumatism (PR) is a form of inflammatory arthritis that can be challenging to diagnose due to its intermittent nature and similarity in symptoms with other conditions. The differential diagnosis of PR involves considering various diseases that can cause an intermittent pattern of arthritis.
Conditions to Consider:
- Systemic autoinflammatory disorders (periodic fever syndromes)
- Whipple's disease
- Arthritis associated with hyperlipidemia
- Intermittent hydrarthrosis
- Other inflammatory and autoimmune diseases
These conditions can present with similar symptoms, such as joint inflammation and pain, making it essential to consider them in the differential diagnosis of PR.
Blood Tests:
In addition to clinical evaluation, blood tests can be used to help diagnose PR. These may include:
- Rheumatoid factor
- Anti-CCP antibodies
- Anti-nuclear antibodies
These tests can help rule out other conditions and support a diagnosis of PR.
Clinical Presentation:
The diagnosis of PR is primarily clinical, with a presentation of very short-lasting joint attacks with a relapsing/remitting course. The differential diagnosis of PR is quite wide due to the various diseases that can cause an intermittent pattern of arthritis.
References:
- [1] Palindromic rheumatism is the paradigm of this type of condition, but other diseases such as systemic autoinflammatory disorders (periodic fever syndromes), Whipple's disease, arthritis associated with hyperlipidemia, intermittent hydrarthrosis and other diseases should be taken into account in the differential diagnosis of patients with [11].
- The differential diagnosis is extensive and includes different types of rheumatic or autoinflammatory diseases, sometimes sharing similar clinical features [5], [10].
- Diagnosing the cause of intermittent arthritis is a challenging condition for rheumatologists due to the various differential diagnosis that includes a wide range of autoinflammatory, autoimmune, and inflammatory diseases with similar clinical features [14].
Additional Differential Diagnoses
- Intermittent hydrarthrosis
- Systemic autoinflammatory disorders (periodic fever syndromes)
- Arthritis associated with hyperlipidemia
- Other inflammatory and autoimmune diseases
- disease
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