Palindrome rheumatism / palindrome arthritis 3.2/5 (5)

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Palindrome arthritis is also called palindrome rheumatism. The condition is rare, but characterized by arthritis (arthritis) which comes and goes with days-few weeks duration. It can take several months between each time new inflammation occurs. It is debated whether palindrome rheumatism is the beginning of Rheumatoid arthritis because 50-67% develop rheumatoid arthritis in the course (reference: L. Ellingwood, 2019). Palindrome rheumatism also occurs in children (reference: Butbul-Aviel 2018). "Palindrome" alludes to the state coming and going.

Symptoms and examination findings

Arthritis (arthritis) occurs episodically and abruptly at erratic intervals. Often six tendinitis (tenosynovitis) as well. The inflammation may also be more around the joints (periarticular inflammation) in soft tissues compared to Rheumatoid arthritis . This must have been the reason for that Hench and Rosenberg who first described the disease (in 1944) originally chose the term palindrome the consept of rheumatism and not palindrome arthritis.

Elevated inflammation tests (CRP, SR) are detected in seizures during seizures. Rheumatic factors (RF) and anti-CCP antibodies are often present, such as rheumatoid arthritis. Between seizures one is without symptoms and one then has normal inflammation tests (CRP, SR) in the blood. 

Each arthritis attack lasts from hours to 2 weeks. All Iedd can be attacked, often different from time to time. Most common, however, are arthritis of the wrists and finger joints (MCP joints and PIP joints). The distribution of arthritis thus corresponds to rheumatoid arthritis. 

Similar conditions / differential diagnoses

Chronic viral infections and allergies can also cause varying joint swellings, but most often without signs of inflammation in blood samples. Also Familial Mediterranean fever (mutations in the MEVF gene) should be ruled out, especially in ethnically predisposed individuals with arthritis without RF and anti-CCP antibodies. Other diagnoses that can eventually be related are Whipples diseaseBehcet's disease og SLE (Lupus) and established rheumatoid arthritis.

Intermittent hydrathrosis (XNUMXH) characterized by periodic inflammation with fluid (hydrops) in the knees. However, blood tests do not show results in rheumatoid arthritis tests (RF, anti-CCP) and persistent arthritis rarely develops. Prolonged phases without seizures are often seen (reference: Canete JD, 2006). Treatment-resistant cases have had the therapeutic effect of the IL-1 inhibitor anakinra (reference; Andres, M2013), which may indicate a relationship to autoinflammatory disease.


NSAIDs is most often sufficient. Colchicine has shown effect in some (reference: Schwartzberg M, 1982). Some people have such frequent or severe seizures that anti-rheumatoid arthritis medication should be considered, but results from good studies are not available (reference: Mankia K, 2019).


Palindrome rheumatism can persist for several years. The joint manifestations leave no permanent damage, but about 50% develop Rheumatoid arthritis with persistent arthritis over time, especially if anti-CCP antibody detected in blood test. Other diagnoses that can eventually be related are Whipples disease, Behcet's disease og SLE (Lupus).


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