Abstract
Palindromic rheumatism (PR), a unique clinical entity, has a characteristic clinical presentation with a relapsing/remitting course. It is established that most patients with PR evolve to chronic disease, of which rheumatoid arthritis (RA) is by far the most common. The relationship between PR and RA is unclear, with similarities and differences between the two, and not all patients evolve to RA in the long-term. Therefore, PR is clearly a pre-RA stage for most, but not all, patients. Autoimmunity plays a substantial role in PR, with the same characteristic autoantibody profile observed in RA, although with some differences in the immune response repertoire. Autoinflammation may also be relevant in some cases of PR. Prognostic factors for RA progression are identified but their exact predictive value is not clear. There are several unmet needs in PR, such as the diagnostic criteria and clinical case definition, the pathogenic mechanisms involved in the unusual clinical course, and the evolution to RA, and our understanding of the therapeutic strategy that could best avoid progression to persistent and potentially destructive arthritis.
Highlights
A-36-year-old female office worker presented in the Arthritis Unit with an 8-month history of intermittent joint pain and swelling
The discovery that most, but not all, patients evolved to rheumatoid arthritis (RA) in the long-term [2, 3] and that a significant proportion had the same autoantibody profile: rheumatoid factor (RF) [4] and, more recently, anti– citrullinated protein antibody (ACPA) [5], reinforced the close relationship between Palindromic rheumatism (PR) and RA
In 1959, Ansell and Bywaters, in a clinical meeting of the Heberden Society, presented a study in 28 patients with PR that showed that 18 patients evolved to chronic polyarthritis (13 were RF positive), and suggested that PR was merely a form of pre-RA, since almost all patients would progress to RA in the long term [2]
Summary
Citation: Sanmartí R, Frade-Sosa B, Morlà R, Castellanos-Moreira R, Cabrera-Villalba S, Ramirez J, Salvador G, Haro I and Cañete JD (2021) Palindromic Rheumatism: Just a Pre-rheumatoid Stage or Something Else? Front. Med. 8:657983. doi: 10.3389/fmed.2021.657983
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