Palindromic Rheumatism Research Articles

An evaluation of the impact of seniors on a rheumatology referral clinic: demographics and pharmacotherapy

The aging population is impacting subspecialty areas outside of geriatrics. Rheumatic diseases increase with age. Therapy for these diseases can add to polypharmacy and negatively impact other comorbidities. This is a retrospective chart review of all patients attending a rheumatology subspeciality clinic over 1year. Referrals were prescreened and excluded probable degenerative axial and peripheral disease and chronic pain syndromes. Data were collected on demographics, diagnoses, and medications. Two hundred ninety-five new patients were seen. Seventy-eight (26%) were seniors (age, >65years) with a mean age of 73years (65-90). Comparing the >65 to <65 age groups, the prevalence of inflammatory arthritides (rheumatoid arthritis (RA), psoriatic arthritis, palindromic rheumatism) was comparable: 48% vs 53%; however, osteoarthritis and polymyalgia rheumatica were twice as common in the older group. Comorbidities in the >65 age group included hypertension (31%), osteoporosis (27%), diabetes (15%), hypothyroidism (11%), and coronary artery disease (9%). Only one patient had documented dementia. There were no cases of uncontrolled hypertension identified, and all patients were receiving a mixture of anti-hypertensives. Eighty-one percent of osteoporosis patients were on antiresorptives, but only 40% of prednisone users were taking bisphosphonates. For RA, treatment was somewhat comparable between the groups, with all but two patients receiving disease-modifying antirheumatic drugs. Eleven percent were on biologics. Seniors comprise a significant number of referrals. Pharmacotherapy differs in seniors, with more use of prednisone and a probable contribution of polypharmacy. This study highlights the need for reciprocal knowledge by both geriatricians and rheumatologists to optimize the management of these complex patients.

Palindromic Rheumatism

We present the case of a 56-year-old woman with a one-month history of recurrent, migratory oligoarthritis. Laboratory tests were normal except for positive antinuclear antibody (ANA) titers. Imaging studies were normal. Palindromic rheumatism (PR) was considered as a diagnosis. In this brief report, we discuss the etiopathogenesis, clinical presentation, prognosis and treatment of this entity. We also elaborate on the factors associated with progression to chronic joint disease. It is important for the primary care physician to be aware of this relatively uncommon diagnosis in patients presenting with joint pains and to distinguish it from other causes of recurrent arthritis, especially rheumatoid arthritis (RA).

Clinical features analysis of 22 palindromic rheumatism patients

Objective To analyze clinical features in palindromic rheumatism(PR).Methods To collect clinical data of 22 PR cases with more complete information,and analyze their clinical characteristics.Results In 22 enrolled patients aged 21 ～47 years old,13 patients were male and 9 patients were female.All patients mainly had localized red,swollen,hot,and with painful in the involved joints or periarticular soft tissues.The symptoms could be self relieved after 2 ～ 7 days or relieved after taking non-steroidal anti-inflammatory drugs(NSAIDs),but appeared repeatedly.73%(16/22)of the patients showed that the interval time between attacks was gradually decreasing.General performance was rare.Most laboratory tests were normal,but appeared low titer of antinuclear antibody(ANA) and rheumatoid factor(RF) positive occasionally.Conclusion If the inflammation in or around the joint appearing repeatedly,the symptoms being self improved in short-term or sensitive to NSAIDs,appearing repeatedly without joint deformity nor bone destruction,and autoantibodies being negative in laboratory tests,it should be first considered the diagnosis of PR. Key words: Palindromic Rheumatism; Arthritis; Diagnosis

A Biopsy of Two Cases of Palindromic Rheumatism

A Biopsy of Two Cases of Palindromic Rheumatism

Large elbow nodules in a patient with rheumatoid nodulosis

Rheumatoid nodulosis is an uncommon pathology considered as a particular variant of rheumatoid arthritis associated with subcutaneous rheumatoid nodules, palindromic rheumatism, and mild or no systemic manifest­ation, usually with positive rheumatoid factor and radiological subchondral bone cysts. We describe a 58-year-old man with the diagnosis of seropositive but nondestructive, nondeforming rheumatoid arthritis, who exhibits multiple subcutaneous rheumatoid nodules associated with episodes of intermittent arthralgias and subchondral cystic lesions of the small bones of the hands and feet. Large nodules were surgically removed from the two elbows. They were histologically typical of rheumatoid nodules. All these findings were consistent with the diagnosis of rheumatoid nodulosis.

Familial Mediterranean Fever Presenting as Anti-Cyclic Citrullinated Peptide Antibody Negative Palindromic Rheumatism

A 64-year-old Egyptian man who resides in the United States presented to the rheumatology clinic with 6 months history of episodic recurrent pauci--arthritis along with constitutional symptoms. His Mediterranean ancestry, anti-cyclic citrullinated peptide negativity, and cyclical palindromic rheumatism prompted an investigation for familial Mediterranean fever gene mutation. He was found to have heterozygous 694I gene mutation during MEFV analysis. He also met Liveneh 1 major and 1 minor criteria for the diagnosis of familial Mediterranean fever.

A Case of Palindromic Rheumatism

A Case of Palindromic Rheumatism

Reumatismo palindrómico (Enfermedad de Hench Rosemberg): Caso clínico con respuesta a los glucocorticoides

Palindromic rheumatism is characterized by multiple recurrent episodes of arthritis and periarthritis (mono or oligoarticular) that may last hours or days, disappearing without sequels. We report a 69-year-old male with a history of hypertension and a presumptive diagnosis of gout due to recurrent episodes of arthritis and periarthritis in the last thirty years. They involved at least two joints, lasted few days and were self limited. The patient was admitted due to arthritis and periarthritis of both wrists, knees, ankles, elbows and hands. He presented with fever (38-39 degrees C), intense articular pain and anorexia. With a presumptive diagnosis of palindromic rheumatism and the lack of response to non steroidal anti inflammatory drugs, methylprednisolone 20 mg/od per os was started, with an excellent response.

Contribution of anti-CCP antibodies, proximal interphalangeal joint involvement, HLA-DRB1 shared epitope, and PADI4 as risk factors for the development of rheumatoid arthritis in palindromic rheumatism

Objectives: To determine which variables at baseline are predictive for the development of rheumatoid arthritis (RA) from palindromic rheumatism (PR) in a Japanese population.Methods: Anti-cyclic citrullinated peptide (anti-CCP) antibodies, joint involvement pattern, genotypes of HLA-DRB1, peptidylarginine deiminase (PADI4), and protein tyrosine phosphatase (PTPN22) were examined in 28 patients with PR at baseline, and their clinical outcome was prospectively evaluated. The same variables were also investigated in 38 healthy controls.Results: Eleven out of 28 patients with PR developed RA. The prevalence of anti-CCP antibodies in the PR patients who developed RA was significantly higher compared to the patients who did not. Proximal interphalangeal (PIP) joint involvement at baseline was also predictive towards the development of RA. Compared with the controls, differences in the frequency of single-nucleotide polymorphism (SNP) on padi4_104 [T(RA susceptible)→C(RA non-susceptible)] and the presence of an RA susceptible homozygote of the PADI4 haplotype were detected in patients with PR whereas we could not find any further difference in PR patients who developed RA compared to PR patients who do not develop RA in PADI4. None of the subjects possessed the PTPN22 SNP (1858C→T). Cox regression analysis revealed that anti-CCP antibodies as well as PIP involvement are the most relevant variables for the development of RA from PR. None of the PR patients with either HLA-DRB1*SE alleles (or the HLA-DRB1*0405 allele) or anti-CCP antibodies developed RA.Conclusions: Anti-CCP antibodies, in relation to HLA-DRB1*SE carriership, and PIP involvement are predictive for the development of RA from PR in the Japanese population.

Predicting the Progression of Palindromic Rheumatism to Rheumatoid Arthritis: The Role of Ultrasonography and Anti-cyclic Citrullinated Peptide Antibodies

We investigated whether sonography and anti-cyclic citrullinated peptide (anti-CCP) antibodies in Chinese patients with palindromic rheumatism (PR) during active episodes are of predictive value for development of rheumatoid arthritis (RA). Clinically involved regions of 84 PR patients during active episodes were examined with ultrasonography using a 6–13 MHz linear transducer. Serum levels of anti-CCP antibodies were determined by enzyme-linked immunosorbent assay. All patients were followed up monthly for 3 years after investigation. Thirteen (15%) of the PR patients had progressed to RA after a mean of 1.4 years (range, 0.4–3.0 years). Of these 13 patients, 11 patients (85%) had sonographic features of synovitis and 8 patients (62%) had a positive anti-CCP antibody test. The absence of sonographic features of synovitis during active episodes provided a very high 3-year predictive value in excluding the possibility of progression to RA for PR patients with a negative anti-CCP antibody test. Both the sonographic findings of synovitis and a positive anti-CCP antibody test were significant predictors for progression of PR to RA within 3 years by backward stepwise logistic regression analysis. Sonographic examination together with an anti-CCP antibody test during active episodes is useful for predicting the progression of PR to RA.

The spectrum of MEFV clinical presentations-is it familial Mediterranean fever only?

FMF is an autosomal recessive hereditary disease, associated with a single gene named MEFV. This gene is considered to be responsible only for FMF. In the present study, we tried to find out whether the MEFV gene is associated with or responsible for clinical conditions other than FMF. We looked for patients who presented with signs and symptoms not typical for FMF but carried MEFV mutations. We also searched for reports about similar conditions in the English medical literature, and we surveyed the website 'Infevers' for MEFV mutations defined as associated with 'atypical FMF'. We encountered three patients carrying MEFV mutations who presented with distinct clinical presentations not typical of FMF. We identified additional reports about MEFV-related non-FMF disease entities such as palindromic rheumatism. By screening the 'Infevers' website, we further disclosed 13 cases with MEFV mutations that were defined as 'atypical FMF' and 4 cases categorized as 'recurrent arthritis'. These findings suggest that the MEFV gene is associated with clinical conditions other than FMF. Changing our concept regarding the MEFV gene and its link to such clinical phenotypes may call for a higher awareness of the existence of additional autoinflammatory diseases. Furthermore, a correct diagnosis of these MEFV gene mutation-associated syndromes will justify a therapeutic trial with colchicine, thereby relieving suffering of many patients who up to now have been misdiagnosed.

Palindromic rheumatism: a descriptive report of seven cases from North Dakota and a short review of literature

The population of North Dakota is predominantly of Scandinavian (Norwegian) or German descent. We analyzed a cohort of all patients diagnosed with palindromic rheumatism (PR) and followed-up (by the investigator PK) at the St. Alexius Medical Center, Specialty Clinics, Bismarck, North Dakota, from August 16, 2006 to September 16, 2008. Standard statistical methodology was used to analyze the data. The proportion of patients with PR out of the total number of patients with rheumatoid arthritis (RA) seen during the timeframe of this study at our institution was 0.9%. The demographics, clinical features, and response to treatment of our patient-population with PR were quite similar to what has been described in the literature. However, we did not observe an evolution of PR into rheumatoid arthritis or any other "identifiable" inflammatory arthropathy although the follow-up was done very regularly (at least every 3 months), the average duration of follow-up being 12.1 months. Also, testing for the HLA B27 allele was positive in 3 (42.86%) patients, much higher than the "background" prevalence of this gene. This small, longitudinal study describes the epidemiology, clinical features, laboratory and radiographic findings, and course of PR in a small but closed community. This is the first descriptive report of PR to the best of our knowledge from the unique state of North Dakota.

Association of Ultrasonographic Findings of Synovitis With Anti-Cyclic Citrullinated Peptide Antibodies and Rheumatoid Factor in Patients With Palindromic Rheumatism During Active Episodes

The purpose of this study was to investigate whether the presence of ultrasonographic findings of synovitis is associated with the presence of anti-cyclic citrullinated peptide (CCP) antibodies and rheumatoid factor (RF) in patients with palindromic rheumatism (PR) during active episodes. Clinically involved regions of 84 patients with PR during active episodes were examined with high-resolution ultrasonography. Serum levels of anti-CCP antibodies were determined by an enzyme-linked immunosorbent assay, and RF levels were measured by nephelometry. Thirty patients (36%) had ultrasonographic findings of synovitis during active episodes. Significantly higher positive rates of anti-CCP antibodies and RF were observed in patients with PR who had ultrasonographic findings of synovitis compared with those who had no ultrasonographic findings of synovitis (26.7% versus 5.6%; odds ratio, 6.18; P < .05; and 30.0% versus 5.6%; odds ratio, 7.29; P < .01, respectively). The intraobserver and interobserver agreement for the detection of synovitis and Doppler signals by ultrasonographic assessment was excellent. Ultrasonography is a reliable method for assessing the presence of synovitis in patients with PR during active episodes. The ultrasonographic findings of synovitis are associated with the presence of anti-CCP antibodies and RF in patients with PR.

Palindromic Rheumatism: Longterm Outcomes of 60 Patients Diagnosed in 1967–84

To study longterm outcomes of 60 patients with palindromic rheumatism (PR) diagnosed in 1967-1984. A cohort of patients with PR was identified in Jyväskylä Central Hospital in 1967-84, and reexamined in 1984-86. In 2006, medical records of the patients were reviewed to analyze the proportion of patients who had developed chronic rheumatoid arthritis (RA), had joint replacement surgery, or had died. Patients' health status was reviewed by mail questionnaires including functional status on the Health Assessment Questionnaire (HAQ), pain, and the number of painful joints. Forty patients developed chronic RA over the observation period of over 20 years, among whom 38 patients within 10 years and 2 patients after 10 years. Twenty-four patients had died by 2006, 17 (42%) in the RA group and 7 (35%) in the non-RA group. Nine patients, all in the RA group (23%), had received 1 or more joint replacements. The mean HAQ score was 0.57 in the non-RA survivors (mean age 70 yrs), compared to 0.89 in the RA group (mean age 66 yrs) (p = 0.020, adjusted for age). Pain scores and the number of painful joints were similar between the groups. Two-thirds of the patients with PR developed chronic arthritis. The risk to develop chronic arthritis remained over 10 years. The RA group was characterized with functional declines and having joint replacements as longterm outcomes of the disease.

Systemic Lupus Erythematosus Develop Seven Years after Acquisition of Acquired Hemophilia a in a Patient with Palindromic Rheumatism: A Case Report

Acquired hemophilia A is a rare disease caused by the spontaneous development of autoantibodies against coagulation factor VIII. About half of these cases are idiopathic and 5% of them are associated with systemic lupus erythematosus (SLE). To our knowledge, in prior case reports of this cohort, acquired hemophilia A appeared concurrently with, or around 6 years after the development of SLE . Herein, we report the first case of a patient with palindromic rheumatism who developed SLE 7 years after acquisition of acquired hemophilia A.

Diagnostic Utility of AxSYM Anti-Cyclic Citrullinated Peptide Antibody Assay

The presence of rheumatoid factor (RF) is one of the classification criteria of the American College of Rheumatology (ACR) for rheumatoid arthritis (RA), but it has a limitation of low specificity. We compared the diagnostic utility of anti-cyclic citrullinated peptide (CCP) antibodies analyzed by an automated immunoassay system with that measured by a 96 well plate ELISA method. The RF and anti-CCP antibodies were determined in 172 serum samples: 52 RA patients, 73 disease controls (systemic lupus, Sjogren's syndrome, palindromic rheumatism), and 47 healthy controls. Anti-CCP antibodies were measured by DIASTAT 96 well plate ELISA method (Axis-Shield Diagnostics, UK) and AxSYM automated microparticle enzyme immunoassay system (Abbott Laboratories, USA). RF was assayed by latex immunoturbidimetry (Toshiba 200 FR, Japan). The diagnostic performances of these tests were compared using a ROC curve analysis, and linearity and precision analysis of AxSYM anti-CCP was carried out. The sensitivities of RF, DIASTAT anti-CCP, and AxSYM anti-CCP were 78.8%, 84.6%, and 82.7%, respectively and the specificities were 72.5%, 88.3%, and 88.3%, respectively. On ROC curve analysis, the area under the curve was 0.924 for AxSYM anti-CCP, 0.886 for DIASTAT anti-CCP, and 0.847 for RF. AxSYM anti-CCP showed a good linearity, and within-run and total-run precision. Diagnostic performance of automated AxSYM anti-CCP assay was comparable to that of DIASTAT 96 well plate ELISA method. AxSYM anti-CCP assay has an advantage of random access capability and will be useful in laboratories with low sample number and/or with a need of rapid turnaround time.

Rheumatology

Rheumatology

Magnetic resonance imaging of palindromic rheumatism

A 44-year-old man with intermittent asymmetric migratory oligoarthritis lasting the recent decade was admitted to our hospital. Considerable specific biomarkers for rheumatoid arthritis such as anti-agalactosyl IgG antibody are all negative. He was diagnosed as palindromic rheumatism (PR). Although hand X-rays showed no remarkable findings, hand magnetic resonance imaging (MRI) detected pannus and bone erosion. PR is defined as the disease characterized by short-lasting attacks of acute oligoarthritis, without radiographic changes. To our knowledge, the findings of MRI for PR have not been previously described. We propose that MRI findings in patients with PR is useful tool to distinguish PR from rheumatoid arthritis (RA) or other RA related diseases.

An alternative, autonomic rationale for decreased risk of myocardial infarction in patients with rheumatoid arthritis responsive to anti–tumor necrosis factor therapy: Comment on the article by Dixon et al

Degeus C, Thomson M, et al. HLA and cytokine gene polymorphisms in relation to occurrence of palindromic rheumatism and its progression to rheumatoid arthritis. J Rheumatol 2002;29:2319–26. 4. Lidar M, Kedem R, Mor A, Levartovsky D, Langevitz P, Livneh A. Arthritis as the sole manifestation of familial Mediterranean fever. J Rheumatol 2005;32:859–62. 5. Canete JD, Arostegui JI, Queiro R, Sanmarti R, Ballina J, Bosch X, et al. Association of intermittent hydrarthrosis with MEFV gene mutations. Arthritis Rheum 2006;54:2334–5.

The Role of Anti-Cyclic Citrullinated Peptide Antibodies in Predicting Progression of Palindromic Rheumatism to Rheumatoid Arthritis

The Role of Anti-Cyclic Citrullinated Peptide Antibodies in Predicting Progression of Palindromic Rheumatism to Rheumatoid Arthritis