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• W2211704603 abstract "A 53-year-old African-American man presented with the complaint of episodic pain and swelling in his shoulder, wrists, metacarpophalangeal, interphalangeal, knee, and ankle joints for 16 years. He was diagnosed with scrofuloderma 16 years prior when he completed 4-drug antituberculosis therapy for 9 months. He subsequently developed multiple joint pain and swelling. He denied joint stiffness or diurnal variation in symptoms. There were no identifiable factors that triggered the symptoms. His symptoms lasted from several hours to a few days and subsided spontaneously. He was evaluated subsequently by several physicians, but physical findings of arthritis were not present during examination. Skeletal radiographs also were done, which did not show any abnormalities. He was referred subsequently to Rheumatology. He had synovitis of the right wrist on physical examination, and his erythrocyte sedimentation rate level was elevated (50 mm/h), which raised the suspicion for inflammatory arthritis. Autoimmune work-up was negative for rheumatoid factor, antinuclear antibody, anti-double-stranded DNA antibody, anticitrullinated peptide antibody, anti-Sjögren's syndrome-related antigen A, anti-Sjögren's syndrome related antigen B, and antineutrophil cytoplasmic antibody. Tests for human immunodeficiency virus and tuberculosis were also negative. Repeat skeletal radiographs did not show any abnormalities. Arthrocentesis of the right wrist joint was done, and joint fluid analysis did not show any significant abnormalities. On a follow-up examination, the patient was found to have bilateral hand and wrist synovitis. Additionally, review of his laboratory tests revealed elevated erythrocyte sedimentation rate levels during periods of active disease with normalization during remission. This raised the suspicion for palindromic rheumatism; subsequently, he was started on methotrexate and a tapering regimen of prednisone. His symptoms were controlled remarkably with methotrexate with sustained remission. Palindromic rheumatism is defined as articular and para-articular inflammation that lasts from a few hours to several days, which resolves spontaneously and is associated with increase in inflammatory markers during active disease.1Kaushik P. Palindromic rheumatism: a descriptive report of seven cases from North Dakota and a short review of literature.Clin Rheumatol. 2010; 29: 83-86Crossref PubMed Scopus (8) Google Scholar Patients in remission do not have any symptoms, and acute-phase reactant levels are normal. The most commonly affected joints are finger joints, wrists, and knees; however, other joints often are involved.2Hannonen P. Möttönen T. Oka M. Palindromic rheumatism. A clinical survey of sixty patients.Scand J Rheumatol. 1987; 16 (Available at:) (Accessed May 29, 2015): 413-420http://www.ncbi.nlm.nih.gov/pubmed/3423751Crossref PubMed Scopus (52) Google Scholar Despite the occurrence of frequent attacks, the arthritis of palindromic rheumatism characteristically is nondeforming. Diagnostic criteria have been proposed by Hannonen et al,2Hannonen P. Möttönen T. Oka M. Palindromic rheumatism. A clinical survey of sixty patients.Scand J Rheumatol. 1987; 16 (Available at:) (Accessed May 29, 2015): 413-420http://www.ncbi.nlm.nih.gov/pubmed/3423751Crossref PubMed Scopus (52) Google Scholar which require the following: 1) recurrent attacks of sudden-onset mono or polyarthritis or of peri-articular tissue inflammation, lasting from a few hours to 1 week; 2) verification by a physician of at least one attack; 3) subsequent attacks in at least 3 different joints; 4) exclusion of other forms of arthritis. Diagnosing palindromic rheumatism can be particularly challenging because the signs of articular or peri-articular inflammation may have completely subsided at the time of the clinic visit, as demonstrated in our case. Furthermore, many other diseases that cause chronic arthritis, including inflammatory and infectious conditions, can mimic palindromic rheumatism. Interestingly, about one-third of patients with palindromic rheumatism eventually develop rheumatoid arthritis.3Gonzalez-Lopez L. Gamez-Nava J.I. Jhangri G. Russell A.S. Suarez-Almazor M.E. Decreased progression to rheumatoid arthritis or other connective tissue diseases in patients with palindromic rheumatism treated with antimalarials.J Rheumatol. 2000; 27 (Available at:) (Accessed May 4, 2015): 41-46http://www.ncbi.nlm.nih.gov/pubmed/10648016PubMed Google Scholar Involvement of the proximal interphalangeal and wrist joints, female sex, and an older age confer a higher likelihood of evolution to rheumatoid arthritis.4Sanmarti R. Cañete J.D. Salvador G. Palindromic rheumatism and other relapsing arthritis.Best Pract Res Clin Rheumatol. 2004; 18: 647-661Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar Therefore, patients with palindromic arthritis should be monitored for progression to rheumatoid arthritis. Hence, a high level of clinical suspicion is required to make a timely diagnosis. Treatment is equally challenging and is based on clinical judgment and experience, as there are no randomized trials addressing this question. Nonsteroidal anti-inflammatory drugs can be used to treat acute episodes. Disease-modifying antirheumatic drug use is an option for patients with refractory frequent attacks, but the choice of individual medication is unclear.1Kaushik P. Palindromic rheumatism: a descriptive report of seven cases from North Dakota and a short review of literature.Clin Rheumatol. 2010; 29: 83-86Crossref PubMed Scopus (8) Google Scholar Methotrexate may be a viable option, as demonstrated in our case, but further research is needed to devise optimum management for this condition." @default.
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• W2211704603 date "2015-12-01" @default.
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• W2211704603 title "Palindromic Rheumatism: An Unusual Cause of Chronic Intermittent Arthritis" @default.
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