What is Palindromic Rheumatism?
How many kinds of Rheumatoid Arthritis are there Anyway?
Nobody knows for sure, but the more you learn, the weirder it seems. Here is a type of inflammatory arthritis which you may not know about. They say it is rarer than the four general courses of Rheumatoid Arthritis which are in our cute chart.
The word “palindromic” comes from two Greek words. (Believe It Or Not: I do read Greek, well ancient Koine Greek anyway. And I do still use a lexicon to help me. Well, back to our program…) Palin is from a word that means again. And, dromos is from a word that means run. So a palindrome runs both ways, like the words “ewe” and “eye.”
Palindromic Rheumatism (PR) or Palindromic RA starts and stops spontaneously. It is a periodic arthritis. It can affect a few joints or a single joint at a time. It usually last only a few days.
The remission period is unpredictable. So the time between attacks varies. However, flares can become more frequent over time.
How is Palindromic Rheumatism like “regular” Rheumatoid Arthritis?
Palindromic rheumatism symptoms
There is pain, inflammation, and disability when a joint is affected. There is of course no known cause or cure. Typically, it affects adults between the ages of 20 and 50. Intriguingly, people with PR often fail the same tests as people with RA – blood tests, that is. The anti-CCP test, the Rheumatoid factor test, and the ESR or sed rate are all used to indicate either RA or PR. However, these blood tests can also be negative in both of these forms of inflammatory arthritis.
Palindromic rheumatism treatment
Palindromic Rheumatism is usually treated with both NSAIDS and steroids (often by injection since fewer joints are involved). Sometimes DMARDs are prescribed for Palindromic Rheumatism, sometimes with the hope of preventing “full blown” RA from developing.
How is Palindromic Rheumatism different from “regular” RA?
The most significant difference between Rheumatoid Arthritis and Palindromic Rheumatism is that PR does not usually cause any permanent damage to joints. In part, Palindromic Rheumatism is diagnosed by the absence of radiographic changes (X-rays often give evidence of RA, at least once it is well established.) And unlike RA, PR is an equal opportunity offender: it attacks both genders equally.
Palindromic Rheumatism related to “regular” Rheumatoid Arthritis?
Probably. About half of the time, people who have Palindromic Rheumatism develop what I call “full blown” RA. Some doctors have speculated about why tests which are quite specific for Rheumatoid Arthritis also correlate with Palindromic Rheumatism. One theory which I have come across, more than once, is that PR is actually an abortive form of RA. In fact, many who have PR actually take DMARDs in hope of forestalling the onset of RA.
NOTE: Read this update on the truth about Palindromic Rheumatism!
More questions about PR?
- Johns Hopkins has a detailed article on PR.
- In Britain, there is a PR society with some good information about PR.
- Rissa, the author of the wonderful RA poem, has a new PR group.
Recommended reading:
- Palindromic Rheumatism Is Not a Rare Form of Rheumatoid Arthritis
- What Is the First symptom of Rheumatoid Arthritis?
- American College of Rheumatology Redefines Rheumatoid Arthritis
NOTE: This post was updated 10/23/09.
I am 83 years of age.I was diagnosed in a VA hospital in the late 70’s in my 40’s with PR. I was told it wold go in and out of remision or go into full blown RA.I would have long periods of remision as long as a year. 5 years ago they became more frequent. I have an HMO insurance, my primary care DR. Caled it gout and treated for gout with Allopurinol which didn’t do any good. I finaly got to a Rheumatologist. She put me on Sulfasalazine then Plaquenil and Methotexate none of them worked. I am now taking Imuran and 5mg Prednisone. Vicodin for the painIt stil comes and gos not as frequent nor as severe. I neveer know where it will strike My last attacks wwere my left hand and my right knee severe paine and swelling and fever at the join.
Thanks for sharing, John. I hope the new medicine cocktail slows down your flares.
I just received my updated diagnosis from my rheumy-doc two days ago. Before this, I had been diagnosed with regular RA. Now, years later, I am rediagnosed with palindromic RA. I am amused, scared and a bit angry. I’ve decided that I will take any and every drug she offers me. I have long ago given up the thought of living a long life….I want a good time, not a long time. BTW, I just turned 59. I am thankful that my regular physician has supplied my with oxycodone for pain, so I can at least rest, if not sleep, during flares. I know that there are many folks whose docs tell them to take ibuprofen……as if! I have just started plaquenil in addition to my methotrexate and am currently on a 2 month course of prednisone to calm the hot spots until the plaquenil kicks in. One evening, with ice packs on both hands, I sat watching a movie with my husband. I periodically gasped or twitched as the pain spikes shot up my nerve paths. My husband turned to me and said “I think I would die if I had to deal with that kind of pain.” I replied “No, you wouldn’t, you’d learn to deal with it, just like me.” What I thought to myself but didn’t say was “No, you wouldn’t, but you would wish you could.” Really, what’s the worst thing about flares, the exquisite level of pain that one cannot escape, even with pain meds, or watching your plans of Things That I Need To Do Today go up in smoke? I have long ago stopped believing in Doc-Speak, but I appreciate that they are trying to help. I once heard a psychologist friend say that we should be happy that most doctors are personality type A people because they hate to fail and will do their very best to help their patients for that very reason. I am so grateful that I have good docs and an excellent husband…..now if only there would be a wonderful discovery of a cure for all autoimmune diseases! Perhaps in our lifetime some personality type A researcher will figure it out.
very clear descriptions, Frances. Thank you for taking the time.
I’m not sure about the palindromic part either, but at least she is prescribing dmards.
Now that I’ve done some reading on PR, I’m pretty sure that’s what I had all along. There were a couple of good years with remission, but 2012 and now 2013 has been getting steadily worse. The increasing of the odd coming and going of the flares annoyed me, and at first I thought that I could beat it, so I didn’t want to take anything more than the methotrexate and occasional prednizone. However as I recently told my rheumy-doc, I am giving up on magical thinking; this isn’t going to be willed away.
It’s funny to read that PR is an “abortive form of RA.” So what is this…RA lite? All of the pain, inflammation and incapacitation, but with none of the joint damage! Well, I’m grateful for that much. When I was younger and dealt with migraines I used to say “Well, it’s not fatal or contagious and at least I don’t have arthritis.” Then when I first got osteo and was just diagnosed with RA, I started saying “At least it’s not lupus.” But now I think I’ll just say “At least I saw the sun come up today.” That’s probably safer.
Good attitude, Frances. My saying is ‘it can always be worse’. When it gets worse, then I will deal with it. Until then, I’m happy with RA lite!
BTW, I think that when my hubby says stuff like that too! 😉
I had a service related injury/surgery about 5 years ago and they told me I would have arthritis ‘someday’. I had flares that started right after my surgery and everytime I got sick, which was often, I had what I thought was a tendonitis flare. Finally after years of NSAIDs (5000+mg/day Aleve) not working, I had a Dr. tell me to go to the VA and get a Rheumy Dr. to check me out. Went and did about a billion blood tests, xrays, exams, etc. and the dx just this last year was PR. Sweet! It has a name!
Too bad I can’t take a whole lot because of my destroyed stomach, so they put me on meloxicam (mobic). It helps, but when the flares are out of control I have to beg borrow and steal to get my Civ Dr to give me some PDN. The ‘lotto of pain’ as I call it, went into remission for a few months after a very strenous/difficult mountain biking excursion. Weird, but the extreme exercise helped. Now, I am back to my usual grab bag of flares. Pick a spot, any spot, which one will it be today? Who knows, but I’m definitly going to start a local Tai Chi class I found on the Arthritis Foundation website. Exercizing is mostly out of the question now for me now. And it looks like this will push me out of my military career, but when a door closes a window opens or something, right? It can always be worse.
I am only just now reaching out for help. My family ‘understands’, but no one can really know until they have been there, done that. The spoon theory helped me tangibly explain it to my kids, that helped me out A LOT. I am excited to have found PR specific resources on this website, thanks Kelly!
Oh my goodness, this sounds exactly like what I am going through! I started having pain, stiffness and swelling fifteen years ago. I found the best rheumy in the area. She called what I had human parvo-virus. As the years went on one shoulder then the other, both hips, and both hands but mostly my right hand have flared. I have had long periods of no activity, sometimes two to three flares per year…sometimes fewer, but last winter I got very sick and since then more and more joints have flared. I have been on four rounds of prednisone in eight months. She now calls it inflammatory arthritis. She says my blood work is normal. I am very frustrated. I will be doing more reading about PR! Thank you for all you do!
My story:
late 2006–sudden, unbearable pain in left hand primarily middle finger and thumb at knuckle joint–by time I get rheumatology appt, it’s gone–CCP 62, RF neg, sed rate 20
—in between I had intermittent similar episodes but pain not as bad—when pain left it was gone and stayed gone for months at a time
early 2007–same sudden unbearable pain right great toe lasting 18 hrs and gone–uric acid negative
2008–episodic pains–knee, wrist, thumb–sudden and intense onset, short lived
CCP 134, RF positive–rheumatologist says I dont fit RA picture esp with asymmetry of joints involved, but says I could go on methotrexate at some point but not now and dx me with synovitis, I admit to being in denial at that time and certainly didnt want to go on this medication
2009–RA (latex turbid)35.7 (ref 0-13.9), same intermittent episodes and extreme fatigue
2010-CRP 5.1, RA factor -positive, RF 42, ANA titer low positive, CCP 57.9, sed rate 27 (ref 0-15), episodes more frequent but less severe in pain, fatigue worse over next couple of years with that being very intermittent too, some days fine, some days literally unable to lift my body off the bed (and I have always been a very active, many will say overactive, person, my entire life)
2013-now with 4 months of less intense pain but constant pain and stiffness in bilateral fingers and feet, with severe stiffness in am lasting 2 hours intensily and markedly decreased but present sensation of stiffness throughout the day, improves with movement, nodules on fingers that subsided, some slight swelling but difficult to notice at times, intermittent knee pain with “bogginess” that comes and goes
went to new rheumatologist–he says “you definitely do not have RA, you have osteoarthritis because you dont have any swelling”, when I asked why my previous CCP and RF were elevated he states “that’s probably due to your hypothyroidism” (which I’ve have since age 25, I’m 50 now). He took no xrays or labwork. He said if I develop deformities to come back otherwise he didnt need to see me again. When I reported to him that I was concerned and wanted to avoid deformities, he stated “there’s no way to do that, you are what you are and you will just have to live with it”. I can deal with the pain I just dont want deformities as I have a very active life. I was a bit taken back by this doctors approach and although I dread a diagnosis of RA, I’ve been an ICU and ER nurse for 30 yrs, and I know that something is going on and affecting my whole body.
Now that I’ve come out of denial, I’m trying to research a bit more, and was enlightened to see this website!!
Any input or suggestions? I dont think its osteo but maybe I am wrong.
Is Palindromic Rheumatism able to affect the organs like “regular” rheumatoid disease is able to?
Louise that’s a great question to ask. I’d like to know the answer to that aswell. Kelly would you or anyone else know the answer. I’m always told never to take Internet information to heart as it may not be right. So who could we ask?
Is this an active site? Does anyone update it with pertinent information? Just curious as I have PR and RA too. Thanks, Ms. Tee
On sites that have blogs, you can usually click on the word Blog or click on the Logo or the Title of the site, then you’ll see the most recent entries. Mine was last night about 3 hours before your comment.
I have been diagnosed since 2016. It has been doing good with hydracloriquine and tramadol. Well end of March 2019 to now I have been having the longest flare up and having the worst pain. I has been continual for about a month hitting each joint everyday with maybe one or two good days in there. I am to my knees crying. I really can’t deal my dr finally put me on a steroid. I am crying every day. Wish I could have something more for the pain. Will find out soon about that. I pray that God can heal me from this, this is the most miserable dx I can think of. I am just hurting constantly in EVERY joint.