Palindromic Rheumatism

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Palindromic Rheumatism "PR" also known as Hench-Rosenberg syndrome or Hench’s syndrome.

"PR" gets it's name from a Palindrome, usually associated with a word like Hannah spelt the same forward and back i.e. comes and goes, but with Rheumatism it basically means comes and goes. Although in my case having had it for many years the pain just doesn't go away any more.

The "comes and goes" also applies to it moving from one joint to another affected joint, sometimes in many joints at once. It also applies to damage caused to joints unlike Rheumatoid Arthritis after a "flare up" (inflammation of the joint and surrounding tissue) the joint usually returns back to normal without any permanent joint damage.

However PR is different to RA (Rheumatoid Arthritis) and Arthritis, as PR doesn’t cause any significant bone damage and PR can also affect the soft tissue away from the joints. Some people get diagnosed as "PRA" in the case of Palindromic Rheumatoid Arthritis and "PA" Palindromic Arthritis. This could be because you have arthritic (or RA) symptoms that come and go, rather than having typical PR symptoms. You may have also been diagnosed as PRA when you have PR because you also have a positive 'RF' (Rheumatoid Factor).  There is a lot of overlap between them.

There aren't any specific numbers on the amount of people in the UK or around the World affected with PR. As some have gone on to develop "RA" (Rheumatoid Arthritis) or another Autoimmune Disorder by the time a diagnosis is made, also with people not being diagnosed or being given a wrong diagnosis. The IPRS is trying to reach all those affected by PR so we do have an idea of the numbers.

Below is a summary of found information about PR that has been compiled together for the ease of having it all in one place. They are the medical worlds definitions and therefore not necessarily the views of the IPRS.

Hench-Rosenberg syndrome
Also known as:             
Hench’s syndrome

Synonyms:                    
Palindromic rheumatism.

Associated persons:
 

Philip Showalter Hench

 

And Edward Frank Rosenberg

Description:
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.

Hench and Rosenberg suggested the term «palidromic rheumatism», meaning «repeated course». It was entered in the international rheuma nomenclature in 1957. Bibliography:

P. S. Hench, E. F. Rosenberg:
Palidromic rheumatism. A «new», often recurring disease of joints (arthritis, periarthritis, para-arthritis) apparently producing no articular residues - report of thirty-four cases; its relation to «angioneural arthrosis,» «allergic rheumatism,» and rheumatoid arthritis.
Archives of Internal Medicine, Chicago, 1944, 73: 293-321.

Hench-Rosenberg Syndrome

WHAT IS PALINDROMIC RHEUMATISM?

Palindromic Rheumatism, also known as Hench-Rosenberg syndrome or Hench’s syndrome, was named for Nobel Prize winner Philip S. Hench and his partner Edward Frank Rosenberg. Mr. Hench (1896-1965) received his doctorate in medicine from the University of Pittsburgh in 1920. His association with the Mayo Clinic began in 1923 when he became first an assistant, then, three years later, Head of its Department of Rheumatic Diseases. At the Mayo Clinic he specialized in arthritic disease. In the course of his work he observed the favourable effects of jaundice on arthritic patients, causing a remission of pain. Other bodily changes, for example pregnancy, produced the same effect. These and other observations led him gradually to the conclusion that the pain-alleviating substance was a steroid. In the period 1930-1938, Dr. E. C. Kendall had isolated several steroids from the adrenal gland cortex. After several years of collaboration with Dr. Kendall, it was decided to try the effect of one of these substances, Compound E (later named cortisone), on arthritic patients. In 1948-1949, cortisone was successfully tested on arthritic patients. Hench also treated patients with ACTH, a hormone produced by the pituitary gland which stimulates the adrenal gland.

Palindromic Rheumatism is a form of an autoimmune disorder. Although PR is listed on the World Rare Disease Listing, it is only one of about five-hundred types of autoimmune disorders. Approximately 50 million Americans, 20 percent of the population or one in five people, suffer from autoimmune diseases. An Autoimmune disorder is a condition caused by an immune response against the body's own tissues. The immune system protects the body from potentially harmful substances (antigens) such as micro organisms, toxins, cancer cells, and foreign blood or tissues from another person or species. Antigens are destroyed by the immune response, which includes production of antibodies (molecules that attach to the antigen and make it more susceptible to destruction) and sensitized lymphocytes (specialized white blood cells that recognize and destroy particular antigens).

Immune system disorders occur when the immune response is inappropriate, excessive, or lacking. Autoimmune disorders develop when the immune system destroys normal body tissues. This is caused by a hypersensitivity reaction similar to allergies, where the immune system reacts to a substance that it normally would ignore. In allergies, the immune system reacts to an external substance that would normally be harmless. With autoimmune disorders, the immune system reacts to normal "self" body tissues.

Normally, the immune system is capable of differentiating "self" from "non-self" tissue. Some immune system cells (lymphocytes) become sensitized against "self" tissue cells, but these faulty lymphocytes are usually controlled (suppressed) by other lymphocytes. Autoimmune disorders occur when the normal control process is disrupted. They may also occur if normal body tissue is altered so that it is no longer recognized as "self." The mechanisms that cause disrupted control or tissue changes are not known. One theory holds that various micro organisms and drugs may trigger some of these changes, particularly in people with a genetic predisposition to an autoimmune disorder.

Palindromic Rheumatism derives its name from the term "palindrome" — a word that is spelled the same forward as backward (examples include "kayak" and "mom") — emphasizing how the illness begins and ends in a similar way. It is a rare type of inflammatory arthritis that causes sudden inflammation in one or several joints, lasts a few hours or up to a few days, and then goes away completely. 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 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. Although the backs of hands, the top of feet and the lower fore arm are also common areas that are affected by swelling of the soft tissue. 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 is a disease of unknown cause. It has been suggested that it is an abortive form of rheumatoid arthritis, since anti-cyclic citrullinated peptide antibodies (anti-CCP) and antikeratin antibodies (AKA) are present in a high proportion of patients, as is the case in rheumatoid arthritis. Unlike RA and some other forms of arthritis, palindromic rheumatism affects men and women equally. It typically affects people between the ages of 20 and 50. No single test can confirm a diagnosis. A doctor may make a diagnosis based on medical history and signs and symptoms. Palindromic rheumatism must be distinguished from acute gouty arthritis and an atypical, acute onset of rheumatoid arthritis. Without specific tests (such as analysis of joint fluid), it may be difficult to distinguish palindromic rheumatism from other episodic joint problems. It is important to note that a person may experience more than one autoimmune disorder at the same time. Laboratory findings are usually normal. 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.

The Podcast (recording) is one I found on the internet, talking about PR. It is interesting to listen to and It was recorded in 2005.

The IPRS clearly would like to thank Dr M ike Mc M ahon for creating this audio blog and for letting us use it.

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Founded 2005.