Bay Biosciences provides high-quality, fresh frozen sera (serum), plasma, and peripheral blood mononuclear cells (PBMC) bio-fluid samples, from patients diagnosed with palindromic rheumatism.
The sera (serum), plasma and PBMC biofluid specimens are processed from patients peripheral whole-blood using customized collection and processing protocols, from palindromic rheumatism patients.
Palindromic Rheumatism (PR) Overview
Palindromic rheumatism (PR) is an autoimmune condition, it is a form of inflammatory arthritis. It causes attacks or flare-ups of joint pain and inflammation that come and go.
The joints look and feel normal between attacks, and the attacks don’t cause any lasting damage to the joints. It is also sometimes known as palindromic arthritis.
A palindromic rheumatism (PR) attack often occurs suddenly without any obvious triggers or warning symptoms. Any joint(s) may be affected, but finger joints, wrists, and knees are most commonly affected.
Symptoms during episodes may include pain, swelling, stiffness, and redness in and around the joints. Some people may have a fever and other systemic symptoms.
Between episodes, people with PR have no symptoms. The time between episodes may last from days to months.
Some patients with palindromic rheumatism (PR) eventually develop chronic rheumatic disease such as rheumatoid arthritis (RA). Others may develop lupus and or other systemic disorders.
Patients with with anti-CCP antibodies detected in a blood test appear more likely to develop rheumatoid arthritis (RA).
Research shows evidence to support that palindromic rheumatism (PR) can be a presenting feature of rheumatoid arthritis RA (or part of the spectrum of RA), rather than a distinct condition.
About 50 percent of patients with palindromic rheumatism eventually develop rheumatoid arthritis (RA).
Palindromic arthritis affects men and women equally and can affect people of any age. It is most common in people between the ages of 20 and 50 years old.
Treatment of PR is challenging, as it has not been studied in randomized trials. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to treat acute episodes. Disease-modifying antirheumatic drugs (DMARDs) may be an option for those with refractory, frequent attacks.
Hydroxychloroquine (a DMARD) reportedly may help control attacks and reduce the risk of progression to rheumatoid arthritis (RA).
Palindromic Rheumatism (PR) Vs Rheumatoid Arthritis
Palindromic rheumatism and rheumatoid arthritis (RA) are both autoimmune disorders. However, they have different effects on the body.
In other forms of arthritis, the tissues in the joints are worn down over time, causing inflammation, pain, and stiffness.
Palindromic rheumatism causes the same symptoms, but, the affected joints return to normal in between attacks. Unlike other forms of arthritis, attacks do not cause lasting damage to the joints.
Signs and Symptoms of Palindromic Rheumatism (PR)
Patients with palindromic rheumatism usually have no symptoms between attacks. This is different from other types of inflammatory arthritis, such as rheumatoid arthritis (RA), as patients with these conditions will have joint problems most of the time.
During an attack of palindromic rheumatism, the joints involved, and the tendons and area around them will feel painful and stiff, and may look swollen. They might also feel tender and hot, and the skin over the joints may look red.
Following are common symptoms of palindromic rheumatism when the attack occurs:
- Fatigue
- Fever
- Pain
- Restricted mobility
- Soreness in the tendons or other tissue around the joints
- Swelling in one of more joints
- Stiffness in affected joints
- Redness in around joints
Palindromic rheumatism patients will not usually experience symptoms between attacks.
The condition does not cause permanent joint damage, but patients with palindromic rheumatism can develop more severe forms of arthritis, which may then cause lasting joint damage.
Causes of Palindromic Rheumatism (PR)
Palindromic rheumatism is rare, and researchers do not yet fully understand the condition, including what causes it. It may be that inflammatory cells move along the lining of the joint, producing the inflammatory reaction.
Inflammation is caused by your body’s immune system and is a normal response to injury or infection. In palindromic rheumatism, the immune system attacks your joints by mistake.
As a result this causes redness, swelling and extra fluid in and around the joints of patients with palindromic rheumatism. This is similar to what happens if you have a cut or wound.
Palindromic rheumatism could involve the following factors or triggers:
- Allergic reactions
- Family history
- Genetics
- Infections
- Trauma
We don’t yet know what causes the inflammation in palindromic rheumatism. Although there may be genetic links, other triggers are likely to play a part, such as infection, hormones or injury.
Palindromic rheumatism affects women and men equally. The condition can start at any age, but it rarely affects children.
Diagnosis of Palindromic Rheumatism (PR)
Diagnosing palindromic rheumatism can be difficult, as it is a rare condition. Doctors may recommend multiple tests before confirming a diagnosis to rule out more common forms of arthritis first, as the symptoms can be very similar.
Palindromic rheumatism is a rare condition, so your doctor may not have seen many PR cases. It can sometimes be confused with conditions like gout and rheumatoid arthritis (RA).
To confirm the diagnosis and to ensure that treatment is started as soon as possible, the doctor may refer the patient to a rheumatologist, who is a consultant with specialist knowledge for these types of conditions.
There is no specific test for the condition, so doctors usually diagnose palindromic rheumatism based on symptoms.
Diagnosis will include an assessment of medical history and a physical examination. A doctor will assess the physical symptoms and may test the mobility of any affected joints.
A diagnosis may also involve imaging tests such as an X-ray. This can help to determine the location and severity of the damage caused by the condition.
Doctors may also use blood tests to test for antibodies and the presence of an infection.
Examination by a Doctor
Since palindromic rheumatism (PR) can’t be diagnosed through one specific test, so a diagnosis will be based on the patients symptoms, as well as blood tests and scans. Your doctor will ask questions and look at your joints to help rule out other forms of inflammatory arthritis.
Ideally, a doctor should examine the patient during an attack, before the symptoms disappear. If you can’t get to a doctor during an attack, taking a good-quality photo of the affected joints and keeping a diary of the symptoms can help your doctor make accurate diagnosis.
Blood Tests
Blood tests for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can be used for a diagnosis, as these show levels of inflammation in your body.
Other blood tests can check for antibodies, such as rheumatoid factor, anti-CCP antibodies anti-nuclear antibodies, which can help to diagnose palindromic rheumatism.
X-Rays
Palindromic rheumatism doesn’t usually cause any damage to the joints. But a doctor may still ask you to have x-rays of your affected joints, so they can rule out other conditions.
Treatment of Palindromic Rheumatism (PR)
Currently there is no cure for palindromic rheumatism, but certain treatments and lifestyle changes can improve patient’s symptoms, reduce the severity of attacks, and improve overall quality of life.
Once the diagnosis of palindromic rheumatism has been confirmed, your care is likely to be shared between your doctor and a rheumatologist. They will monitor the patients condition to make sure you’re not developing another condition that would need different treatment.
Treatments of palindromic rheumatism include the following:
Medication
Medications can be beneficial when the patient is trying to manage their symptoms and slow down the progression of arthritis. These include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), taken regularly, can control inflammation and reduce discomfort and joint stiffness.
- Disease-modifying anti-rheumatic drugs (DMARDs) can be prescribed by a doctor to reduce the frequency and severity of attacks.
Doctors usually prescribe DMARDs when inflammation is severe and long-lasting. They are slower acting than NSAIDs and have more side effects.
Patients should note that DMARDS are immunosuppressants, meaning they suppress the immune system, and a person may be more likely to develop infections.
Disease-modifying anti-rheumatic drugs help by tackling the causes of joint inflammation. They’re used in palindromic rheumatism to reduce symptoms and flare-ups.
Unlike the other drugs mentioned here, DMARDs treat the condition itself rather than just reducing the pain and stiffness it causes.
DMARDs can be used to prevent attacks or reduce the frequency of them in patients who have a more severe form of the condition. They can sometimes take a while to start working, so your doctor will advise you to keep taking them regularly.
The most common DMARD used to prevent attacks of palindromic rheumatism is hydroxychloroquine. However, some people may need stronger DMARDs like sulfasalazine or methotrexate.
When taking some DMARDs, you’ll sometimes need to have regular blood monitoring to check for possible side effects, including problems with your liver, kidneys or blood count.
Steroids
In rare cases, a doctor can inject steroids into the joint to reduce inflammation immediately. They may recommend this when the joint or tendon has become extremely inflamed and is causing significant discomfort to the patient.
Lifestyle Changes
As with any form of arthritis, patients can make some lifestyle changes to manage their symptoms.
Regularly exercising is essential for keeping joints healthy. Rheumatism can restrict mobility and make movement uncomfortable. Nevertheless, inactivity can cause the surrounding muscles to break down, and damage the affected joint itself.
Stretches and exercises that promote flexibility, range-of-motion, and muscle strength around the affected joints can reduce the severity of attacks, as the joints will move more easily and have more support.
Patients should discuss an exercise plan with a doctor or physical therapist. This is vital, so they ensure it is set at the right intensity and does not include any exercises that put too much stress on the affected joints.
Maintaining a healthy weight can also help reduce symptoms. Being overweight can put additional strain on joints, which can make symptoms worse. A regular diet and exercise routine can help.
Managing Palindromic Rheumatism (PR) Symptoms
There are things you can do which may help ease your symptoms and help with your daily activities.
During an Attack
When your pain is very bad, you should rest your joints. You might find wrist splints and insoles for your shoes helpful.
Once the inflammation has settled down, you should start to get moving again by doing gentle exercise. You can also speak to your doctor or rheumatology specialist to see if you should increase your medication.
Ice or heat pads, such as a bag of frozen peas or a hot water bottle, can help ease pain and swelling, although you should take care not to put them directly on your skin. Relaxation exercises can also help.
Pacing your activities will help save your energy and reduce fatigue. A doctor or a physiotherapist will be able to give you advice on this.
Diet and Nutrition
No specific diets have been found to affect palindromic rheumatism, but being overweight will put extra strain on your joints, so it’s important to keep to a healthy weight.
Eating a healthy, balanced diet with plenty of fresh fruit and vegetables is recommended for your general health.
Some people with palindromic rheumatism believe that a particular food appears to trigger their attacks. If you think this may be the case for you, you can try using a food diary, or a diet in which you stop eating that food, known as an elimination diet.
If you decide to try an elimination diet, you should speak to a registered dietitian. They can make sure you’re cutting out certain foods completely, that you’re not missing out on any important nutrients, and give you any support you need.
Complementary Treatments
There’s not very much research that shows the effects of complementary treatments on palindromic rheumatism.
Some people find that fish oils reduce their need for NSAIDs because they have a mild effect on reducing inflammation in the body. Pure fish body oil is thought to be more effective than fish liver oil.
If you want to try complementary medicines or therapies, discuss this with your doctor or nurse specialist first, in case any of the treatments could interact with the medications they’ve given you.
It’s important to go to a therapist who is registered, or one who has a set ethical code and is fully insured.
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