Introduction
Palindromic rheumatism is a type of inflammatory arthritis that is characterized by episodic joint pain and inflammation. It usually causes attacks of pain and inflammation in the joints that wax and wane on their own. In between the attacks, the joints appear normal and the inflammatory attacks do not lead to severe damage to the joints. It is also known as palindromic arthritis.
What Are the Symptoms of Palindromic Rheumatism?
No symptoms usually occur in between the attacks in patients suffering from palindromic rheumatism. The clinical manifestation is entirely different from rheumatoid arthritis which is a type of inflammatory arthritis where the patients complain about joint pain most of the time.
-
The joint, the tendons, and the area surrounding them appear painful, swollen, and stiff during the time of an episodic attack of palindromic rheumatism.
-
The joints may also become warm and tender, and the overlying skin on the joints may appear reddish.
-
These episodic attacks are initiated in one or two hand joints. These joints quickly become stiff, edematous (swollen), and tender.
-
Painful and swollen tendons may also appear along with the swollen joints.
-
These attacks are also known as flares or flare-ups. Attacks can affect one joint to another joint. This flare usually lasts for three to five days. Eventually, this ongoing flare subsides, and the joints and tendons return to normal state.
-
However, frequent these attacks are, they do not cause damage to the joints. In between the palindromic rheumatism attacks, the patients usually feel normal.
-
Fatigue is another common symptom of palindromic rheumatism. The affected individual feels exhausted for a few days to a few weeks. It might affect the individual physically as well as emotionally.
-
It also affects the concentration of the affected person.
The pattern of attack varies for each individual. Attacks in some individuals occur once or twice a year and in some individuals, the attacks might occur every week. In some people, attacks last for a few hours while in some people, they may take several days to subside. Some people might develop nodules beneath the skin of the affected joints.
What Are the Causes of Palindromic Rheumatism?
It is an autoimmune-mediated mechanism in palindromic rheumatism where the joints are mistakenly attacked by the immune system. The inflammation caused due to autoimmune reactions leads to pain, redness, swelling, and extra fluid accumulation in and around the joint spaces of the affected patients. The exact etiology for causing such inflammation is unknown but certain predisposing factors have been found to trigger the response. Genetic factors have also been attributed to its pathogenesis but other triggers such as trauma, injury, certain infections, or hormonal imbalance have also been found to play a role in the pathogenesis of the disease.
Both men and women are affected equally by the condition. Children are rarely affected and there is no age predilection.
How to Diagnose Palindromic Rheumatism?
The diagnosis is usually based on the symptoms of the disease along with hematological tests and imaging scans. The doctor will do a full check-up and examine the joints to exclude other types of inflammatory arthritis. Make sure to visit the doctor during the period of flare.
-
Hematological Tests- Tests forerythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) should be conducted to check the levels of inflammation in the body. Other blood tests such as rheumatoid factor, anti-CCP, and anti-nuclear antibodies can be performed to detect antibodies in a palindromic rheumatism patient.
-
X-Rays- The scans can be done to rule out the disease as well along with other similar conditions.
What Is the Treatment of Palindromic Rheumatism?
The rheumatologist or general physician will suggest certain medications and physiotherapy to treat the condition.
Pharmacological Drugs- Drugs are the mainstay of treatment to treat pain and reduce inflammation, and treat the disease.
-
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)- These drugs are used to minimize pain, inflammation, and tenderness at the time of attacks. They have certain side effects so it is important to take them at the lowest dose.
-
Corticosteroid Injections- Steroid injection might be suggested by the doctor to reduce the pain in the joints or to reduce inflammation in the tendons. They are directly injected into a muscle or a joint. They quickly show results within two to three days.
-
Disease-Modifying Anti-Rheumatic Drugs- Their mechanism of action is to reduce the symptoms and intensity of the attacks. They have the potential to treat the condition rather than minimize the pain. They are used to prevent the occurrence, frequency, and severity of these attacks.
Exercises- Exercise is very essential to keep the joints healthy but during the attacks, the patient might get fatigued. Therefore, it is very important to set the correct balance between physical exercise and rest. Exercises such as stretching and hydrotherapy exercises (water aerobics or water walking) can be performed to keep the joints working properly.
Balanced Diet and Nutrition- There is no specific diet to treat the condition but being obese will unnecessarily strain the joints more. Therefore, it is important to maintain weight. A balanced diet should be consumed with loads of fresh fruits and vegetables to improve overall health. Fish oils have also been found to reduce inflammation of the joints in some people. Pure fish body oil is considered more beneficial than fish liver oil.
How to Manage the Attack Symptoms?
Certain things can be done to ease the symptoms. If the severity of the pain is too much during an attack, immediately rest the joints. Insoles for the shoes and wrist splints might be helpful to alleviate the pain. Gentle physical exercises should be started once the inflammation has subsided. Consult the doctor regularly.
Cold or heat therapy, such as an ice pack or a hot water bottle, can help to relieve pain and swelling. However, one should never apply them directly on the skin. Certain relaxation exercises and meditation might also help the affected individual. The patient can even consult a physiotherapist for his well-being.
Conclusion
Palindromic rheumatism is a disease that requires immediate attention. More research is required in the field of diagnostics that will help to identify the affected ligaments and joints quickly. A quick diagnosis of the condition will help to better understand the condition and improve ways of controlling it and discovering new treatment modalities.
