Palindromic RheumatismDz

ICD-9 Code: 719.30.

ICD-10 Code: M12.3

Definition: A term originally coined in the 1942, palindromic rheumatism refers to episodes of arthritis and/or periarticular inflammation that wax and wane over time.

Cardinal Findings: As initially described, articular and periarticular symptoms typically last a few days or more before spontaneously resolving. Monarticular and polyarticular involvement can both be seen, with greater numbers of joints becoming involved in patients with a persistent course. Joint effusions are inflammatory.

Complications: Approximately one-third of patients with palindromic rheumatism will go on to develop RA. Thus palindromic rheumatism may be a pattern of presentation of early RA for some patients. Patients seropositive for ACPA / anti-CCP antibodies appear to be more likely to ultimately develop RA. Other patients will be found to have another form of arthritis, such as spondyloarthritis. Some patients retain the waxing and waning involvement, without developing signs and symptoms that allow a more definitive diagnosis. Some patients experience spontaneous remission.

Treatment: Therapy of palindromic rheumatism is often guided by both the severity and the persistence of symptoms. Many patients receive therapy with NSAIDs. Corticosteroids, often in the form of intraarticular injections or short oral courses, have been used in severe or refractory cases. DMARDs such as hydroxychloroquine and methotrexate, have also been used.

BIBLIOGRAPHY

Guerne P, Weisman M. Palindromic rheumatism: a part of or apart from the spectrum of rheumatoid arthritis. Am J Med 1992;93:451–460. PMID: 1341421

Cabrera-Villalba S, Ramirez J, Salvador G, et al. Is there subclinical synovitis in patients with palindromic rheumatism in the intercritical period? A clinical and ultrasonographic study according to anticitrullinated protein antibody status.J Rheumatol. 2014 Aug;41(8):1650-5. PMID: 25028368