Arthritis More Arthritis Types & Related Conditions What Is Palindromic Rheumatism? By Carol Eustice Carol Eustice Verywell Health's Facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Updated on October 08, 2022 Medically reviewed by Scott Zashin, MD Medically reviewed by Scott Zashin, MD Verywell Health's LinkedIn Scott J. Zashin, MD, specializes in the treatment of rheumatologic and musculoskeletal conditions using both traditional and alternative therapies. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Prognosis Palindromic rheumatism (PR) is a rare type of inflammatory arthritis that causes symptoms to flare up sporadically and resolve without causing any lasting damage to joints. Symptoms that arise during palindromic rheumatism episodes—including joint pain and inflammation—are similar to those of rheumatoid arthritis (RA), but they differ in that they occur without warning and can last hours or a few days. About half of people with palindromic rheumatism will go on to develop RA. krisanapong detraphiphat / Getty Images Symptoms of Palindromic Rheumatism Palindromic rheumatism is characterized by painful attacks of the joints and surrounding tissue. Resulting symptoms, which are common to some other forms of arthritis, include: PainSwellingStiffnessRedness in and around the joints The large joints, knees, and fingers are most commonly affected in palindromic rheumatism and may or may not be accompanied by fever or other systemic symptoms. PR has a distinct pattern of symptoms that distinguish it from other types of joint pain. Typical episodes: Involve one to three jointsStart suddenly and last hours or days before spontaneous remission occursRecur with unpredictable frequency, though some people can recognize patterns and identify triggers Between episodes, people with palindromic rheumatism are symptom-free and can go for days or months between attacks. Signs and Symptoms of Arthritis Causes Palindromic rheumatism is considered an overlap syndrome. It has characteristics of both autoimmune and autoinflammatory diseases, but the underlying cause is unknown. It is, however, considered to be on the rheumatoid arthritis continuum and may elevate your risk of eventually developing RA. Some researchers believe it's simply a very early stage of RA. Palindromic rheumatism affects men and women equally and typically starts between the ages of 20 and 50. Some researchers suspect that episodes are caused by an allergic reaction, though there is a lack of convincing evidence to support this theory. Palindromic rheumatism is categorized as a rare disease, with approximately 250,000 people living with it in the United States. Causes and Risk Factors of Autoimmune Disease Diagnosis The is no one test that definitively diagnoses palindromic rheumatism. It is diagnosed based on symptoms and the ruling out of other conditions. Your healthcare provider will start by taking a complete medical history including details of your symptoms and how often they occur. Lab tests may include blood work and urinalysis including: Rheumatoid factor Anti-cyclic citrullinated peptide (anti-CCP) C-reactive protein Sedimentation rate Most people with palindromic rheumatism have some RA-related antibodies, which may show up on some of these tests. Your healthcare provider may also take X-rays and ultrasound imaging to differentiate between types of joint inflammation. In PR, X-rays will be normal—i.e., without evidence of joint space narrowing or joint damage, which are common in RA. Ultrasound assessment will commonly show non-synovial extracapsular inflammation without synovitis (inflammation of synovial tissue). Diseases That Mimic RA Treatment During attacks of palindromic rheumatism, your healthcare provider may suggest prescription nonsteroidal anti-inflammatory drugs (NSAIDs) to help with pain and inflammation. Oral steroids or local steroid injections may also be included in the treatment plan for flares. On-going treatment, taken daily to prevent future attacks, may involve disease-modifying anti-rheumatic drugs (DMARDs). Plaquenil (hydroxychloroquine) is the most common DMARD for palindromic rheumatism. Stronger drugs like methotrexate and sulfasalazine, which are frequently taken for other forms of arthritis, may also be options. The use of anti-malarial drugs like Plaquenil in people with palindromic rheumatism has been associated with a decreased risk of developing RA or other connective tissue diseases. Joint Pain Causes and Treatment Options Self-Care You can take added steps to help manage your symptoms during a flare, including: Resting painful jointsApplying ice or heatPacing yourself It's unknown whether your diet plays any role in palindromic rheumatism, but an anti-inflammatory diet is sometimes recommended. Foods to Eat on the Anti-Inflammatory Diet Prognosis Palindromic rheumatism can take a few different disease paths. In some people, symptoms resolve without additional episodes, while others continue to have sporadic flare-ups. For many, though, PR is a prodromic syndrome that leads to other rheumatoid conditions. A review of data from multiple studies on palindromic rheumatism showed various outcomes for people with the condition, including: 15% entered prolonged remission (no attacks) 48% continued to have palindromic rheumatism with no progression to other disease 37% progressed to RA, other forms of arthritis, or other chronic conditions including lupus, granulomatosis with polyangiitis, Sjögren's syndrome, Behçet’s disease, and polymyalgia rheumatica People with palindromic rheumatism who test positive for anti-CCP or rheumatoid factor are more likely to progress to RA. However, having these markers does not guarantee the disease will progress. When it does, the average time from first PR episode to RA diagnosis is 1.2 years. A Word From Verywell Living with palindromic rheumatism can be unpredictable. You can take control by: Working with your healthcare provider to develop an action plan for treating episodesExploring treatment options to prevent episodes and reduce your risk of PR progressing to RAPracticing self-care to maintain good health between flares Types of Arthritis and Rheumatic Disease 9 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Arthritis Foundation. Palindromic arthritis. National Institutes of Health, Genetic and Rare Disease Information Center. Palindromic rheumatism. Mankia K, Emery P. Palindromic rheumatism as part of the rheumatoid arthritis continuum. Nat Rev Rheumatol. 2019;15(11):687-695. doi: 10.1038/s41584-019-0308-5. Mankia K, D'Agostino MA, Wakefield RJ, et al. Identification of a distinct imaging phenotype may improve the management of palindromic rheumatism. Ann Rheum Dis. 2019;78(1):43-50. doi:10.1136/annrheumdis-2018-214175 Cabrera-Villalba S, Sanmart R. Palindromic rheumatism: a reappraisal. Int J Clin Rheumatol. 2013;8(5), 569–577. doi:10.2217/IJR.13.51 Versus Arthritis. Palindromic rheumatism. Mankia K, Emery P. What can palindromic rheumatism tell us? Best Pract Res Clin Rheumatol. 2017;31(1):90-98. doi: 10.1016/j.berh.2017.09.014 Cabrera-Villalba S, Sanmarti R. Palindromic rheumatism: a reappraisal. Int Journ Clin Rheum. 8(5):569–577, October 2013. doi:10.2217/ijr.13.51 Castellanos-Moreira R, Rodriguez-Garcia SC, Gómez-Puerta JA, et al. Rheumatoid arthritis initiating as palindromic rheumatism: A distinct clinical phenotype? J Rheumatol. 2020;47(5):652-657. doi:10.3899/jrheum.190061 By Carol Eustice Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit