Palindromic Rheumatism

Symptoms and Diagnosis

Some definitions below are how the medical world diagnose it.

The attacks usually affect only one or two joints at a time. They start abruptly and can last for hours or days. The attacks may recur with unpredictable frequency — from every few days to every few months. Although palindromic rheumatism can recur over many years, it doesn't usually cause permanent joint damage.

The large joints are most commonly involved.
The soft tissues - are also involved with the swelling of the periarticular tissues, especially heel pads and the finger pads.
Nodules may be found in the subcutaneous tissues.

Constitutionally, the patient may or may not have a fever, and swelling of the joints.

Palindromic Rheumatism describes a syndrome where there are recurrent episodes of pain swelling warmth and stiffness of joints. The problem usually involves 2 or 3 joints, which have onset over hours and last days - weeks, before subsiding. However episodes of recurrence form a pattern, with symptom free periods between attacks lasting for weeks to months.

The unusual features of this syndrome consists of the sudden and rapidly developing afebrile attacks of arthritis or periarthritis, occasionally paraarthritis, that continue for a few hours or a few days and then disappear completely. There is pain, redness, swelling, and disability of one (usually) or multiple joints. The interval between recurrent attacks is extremely variable. There are no joint deformities or roentgenographic manifestations.

Blood tests may show an elevation of the ESR and CRP, but are otherwise unremarkable.
Rheumatoid factor may be present especially in the group that is likely to develop Rheumatoid arthritis.

ESR also known as Sed rate, Sedimentation rate or Erythrocyte sedimentation rate is an indirect measure of the degree of inflammation present in the body. It actually measures the rate of fall (sedimentation) of erythrocytes (red blood cells) in a tall, thin tube of blood. Results are reported as how many millimetres of clear plasma are present at the top of the column after one hour. Normally, red cells fall slowly, leaving little clear plasma. Increased blood levels of certain proteins (such as fibrinogen or immunoglobulins, which are increased in inflammation) cause the red blood cells to fall more rapidly, increasing the ESR.

CRP also known as C-reactive protein is a substance made by the liver and secreted into the bloodstream. Its concentration increases within a few hours after the start of an infection, making it especially valuable for monitoring infections. Its rise in the blood often precedes pain, fever, or other clinical indicators. The level of CRP can jump a thousand-fold in response to inflammation It drops relatively quickly as soon as the inflammation passes, making it a valuable test to monitor effectiveness of treatment.

Since PR is an autoimmune disorder it may be partly inherited through genes, but other factors are probably at work, including some kind of a trigger for the gene, perhaps bacteria or viruses. The disease is not contagious, however. Some scientists also think that changes in certain hormones may promote RA in people with certain genes who have been exposed to the triggering agent.

The ability to develop an autoimmune disease is determined by a dominant genetic trait that is very common (20 percent of the population) that may present in families as different autoimmune diseases within the same family. The genetic predisposition alone does not cause the development of autoimmune diseases. It seems that other factors need to be present as well in order to initiate the disease process. It is important for families with members who have an autoimmune disease to mention this fact when another member of the family is experiencing medical problems that appear to be difficult to diagnose.

In the language of someone who has had it for well over 18 years.

PR is usually extreme pain/inflammation in the joints and or surrounding tissue area. You may get Inflammation (Inflammation includes Redness, A Swollen Joint and Heat in the affected area) with the affected joint or just pain, stiffness and numbness during a "Flare Up".

"Flare Ups" can happen at any time and for any reason. The amount of pain and inflammation varies from joint to joint or time to time and person to person. Some people have PR in one or two places only, where I and others have/had it in every joint from my little toe to my jaw. A flare up usually last between minutes to on average a week, however it can last several weeks especially when the inflammation is transient and moves around the joint or the joint is being constantly over used.

A Flare Up can happen once/several times a month/year and then the person goes into remission for months or years (usually in the beginning) or it can happen more frequent. With Flare Ups happening more and more frequent to constant or over lapping Flare Ups. This irregular pattern can make it difficult to diagnose.

PR can and does go in to remission on it's own you may have had bad flares for days, months or even years and then a break. No one knows why but it happens, you may be on medication at the time and think it is now working. The break in flares is a blessing which will get you wondering why, what has happened to cause this be it medication or a change in your life etc. My advice is to enjoy it whilst it lasts as it may just come back when you least expect it, with no invitation or explanation why.

Your body (as in my case) can be like a pinball machine with pain, stiffness, aches (niggles) just going from joint to joint or several joints together. This is because inflammation is present in the sub levels (not visible by the eye) of all the joints and that is the pain you feel but can't see. So even though you haven't a visible red swollen joint because of the amount of inflammation present, you still get the pain.  I have this all the time with major flare ups on top of that.

There can be many other symptoms that seem to be involved or happen around the same time as a flare up, too many to mention as everyone seems to experience different things but some examples are:- flue, sore throat, allergies, head aches and depression.

If you have experienced a sore throat or a salmon coloured rash around the time of a flare up you may find the Stills website of interest. You can find the link on the links page.

There shouldn't be any shame with depression, with what we have to go through it's justified. Many people with PR have had to wait years for a diagnosis and to have their symptoms acknowledged. Many suffers have felt at sometime that they were going mad again this is understandable with their situation. Not all people need medication or can take medication with the side effects. Usually a diagnosis helps the sufferer with their depression and they wont need to take any medication. However some may need to take an anti-depressant to help them through difficult times.

If you are suffering with depression you should seek medical advice, however the forum is always available if you need an understanding person to listen.

Tips On How To Get A Proper Diagnosis

These are my tips on how to help you get a proper/quicker diagnosis.

1. If you have been experiencing symptoms mentioned above, seek medical advice and go visit your Dr/GP and if need be ask to see a Rheumatologist.

2. Keep Records, Diary/Journal of your flare ups. The information you need to keep should include:- Which joints are affected, how long the 'flare ups' lasted, days/minutes etc Pain levels experienced and any other symptoms like inflammation, fever and rashes. Also any other information you think may be helpful. If you have anything like inflammation/redness to show, take photos. These records will help your Dr/Rheumatologist to see a history of symptoms, they will also help you see how many times you have been affected and it puts things into some perspective. It can take a while to see a Rheumatologist and like most things you will probably be flare free when you have your appointment. By keeping a record it will help show what you are going through and stop you worrying, trying to remember things that happened a couple of months ago. It also helps if you keep records after a diagnosis with medication as it helps remind you day to day. It will also help you with work or claiming benefits.

3. If you are seeing someone who has never heard of PR or doesn't recognise it exists, ask to see someone else, you can usually be referred to another person. In the UK you can also ask to be referred to see someone outside of your local area. If you live in a country where there is little known about PR print off the IPRS leaflet or information about PR and take it with you to your appointments. I find if you ask for the Dr/Rheumatologists advice about something and ask their opinion on a matter rather than going in telling them what you have, it usually works better.

I will add any more tips as and when I come across them....

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