Palindromic Rheumatism

Palindromic rheumatism is a rare type of inflammatory rheumatism in which the complaints flare up from time to time and then disappear. There is inflammation, pain, swelling in the joints, but permanent damage does not occur. A palindrome is a word or sequence of numbers that has the same meaning as straight and backwards. The beginning and end of palindromic rheumatism progresses with mild complaints, while the middle is the period when the symptoms are most severe. It got its name from this feature. In the period between attacks, the person does not make any complaints.

About half of all palindromic rheumatism develops into rheumatoid arthritis . The most important difference of palindromic rheumatism from rheumatoid arthritis is that it does not cause permanent joint damage or deformity in the joints. Both are autoimmune diseases in which the immune system attacks the body’s own tissues.

It affects men and women equally. It is most common between the ages of 20-50.

Complaints usually start in one or two joints of the hand and may spread to other joints. Attacks can last for several hours or days. Some people may have a few attacks per year, while others may have more frequent attacks. In the duration and frequency of attacks, a personalized pattern can be noticed after a while.

Palindromic Rheumatism Symptoms

  • Redness and swelling in one or more joints
  • Stiffness in affected joints
  • Swelling and stiffness in tendons and other soft tissues around the joint
  • Tiredness. Fatigue may persist for several days or weeks after the attack. It can impair concentration and motivation.
  • low grade fever
  • Symptoms usually disappear between attacks.
  • Attacks can be displaced from one joint to another.
  • It does not usually affect other parts of the body except joints and tendons. Sometimes, nodules may form under the skin around the involved joints.
  • Although this condition does not cause permanent damage to the joints, it can sometimes turn into a more serious rheumatic disease such as rheumatoid arthritis. In this case, the person may develop permanent joint damage.
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How is the diagnosis made?

It can be difficult to diagnose because it is a rare disease. Since complaints such as joint pain, stiffness and swelling are the general symptoms of rheumatic diseases, various tests and diagnostic criteria sets are used to distinguish the diseases from each other.

Medical history and physical examination form the basis of diagnosis. Joints are evaluated for edema, limitation of movement, and pain. In blood tests, features such as markers for specific diseases (RF, anti-CCP, anti-nuclear antibody, etc.) and inflammatory parameters (CRP, ESR) are examined. X-rays may show specific signs of inflammatory rheumatism, such as erosion of the joints. Edema, inflammation, erosion can be evaluated with ultrasonography. If these are insufficient, MRI can be taken.

Why Does It Happen?

Although it is thought to be triggered by environmental factors (infection, trauma, hormonal reasons, etc.) on a genetic basis, the exact cause of the disease is not known.

Treatment

Joint stiffness and muscle wasting can be prevented with regular exercise. A healthy and balanced diet, being at a normal weight are practical measures that help keep the joints healthy. Pain relievers and anti-inflammatory drugs may be prescribed to control symptoms. Drugs classified as disease modifying may be preferred if the attacks are very frequent and seriously reduce the quality of life. If symptoms are limited to one or two joints and are severe, local corticosteroid injection may be given.

It is recommended to avoid straining the joints by resting during attacks. Cold application can reduce edema and inflammation. In order to cope with fatigue, daily activities can be used in an energy-efficient way by placing them in a certain order.

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In about 10-15% of people with palindromic rheumatism, the symptoms disappear after a while. Attacks continue at regular intervals around 30-50%. In the remaining 30-40% patients, the symptoms may worsen and evolve into a more severe rheumatic disease.

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