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What Is Palindromic Rheumatism?

Palindromic rheumatism(PR) is an autoimmune disease characterised by sudden, rapid and recurrent attacks of arthritis. The key here is the...

Palindromic rheumatism(PR) is an autoimmune disease characterised by sudden, rapid and recurrent attacks of arthritis. The key here is the word 'palindromic' which means 'again and again'. These arthritic attacks come and go unlike other arthritic conditions(RA - Rheumatoid arthritis) where the symptoms do not disappear rather progress over time. Palindromic rheumatism is an autoimmune disease like I mentioned in the beginning of the post. What that means is our body's immune system(which is our defence mechanism against infections) starts attacking our own cells. The cells that are usually attacked are those that line our joints. This causes inflammation of the area around the joint resulting in swelling, stiffness and pain. Unlike RA which causes permanent joint damage, PR doesn't. However according to reports, 50% of the people who have PR may eventually also develop RA.

Why am I writing about palindromic rheumatism, you may wonder. Well, let me begin where it all started and that is in the Spring of 2013 when I suddenly developed acute heartburn and reflux and after a couple of visits to the GP and some tests, it was diagnosed as GERD. I was put on medication for 3 months. Around the same time I also developed severe rashes. On my face(mainly on the cheeks) the rashes were red tiny dots while on my upper body, neck, hands and legs they were more like weals. I went to the GP and I was told that it could be seasonal pollen allergy and I was asked to take 1-a-day OTC allergy pills. I started on that. Around 3 months after my GERD onset, with the medication it gradually reduced. The rashes however did not. I went to the GP many times and each time I was told to take allergy pills. It was November 2013 and I was still taking the allergy pills but now I had other problems as well. One fine day, the fingers on my right hand began to swell. Within 3 days they were swollen, stiff, red and painful like sausages. I knew this was something serious and not an allergy, so back I went to the GP. The GP had a look at my fingers and immediately suspected arthritis. I was sent for blood tests. One of the blood tests was for Rheumatoid factor - an antibody that is found in the blood of nearly 80% of adults with RA. My results came negative and the GP said its not arthritis, probably some food allergy. I was asked to take pain killers to manage the pain and sent back saying the swelling would go away on its own.

Well, the swelling stayed for almost 3 weeks during which time my fingers were stiff and painful. I could not hold anything in my right hand - not even my toothbrush. I lost the grip in my right hand. The fingers became sensitive to heat and cold. And I was still battling the rashes. After 3 weeks the swelling started receding. I went back to the GP many times after that, but no luck. Since then there were periods of flare-ups and periods without any swelling/stiffness. In January 2014 I again went back to the GP and this time was seen by a Locum doctor who looked at my swollen fingers and suspected arthritis. Again I was sent for blood tests and the Rheumatoid factor test was negative. But this time I was referred to a specialist. I was told I would get a letter from the Rheumatologist soon. I finally got an appointment with the Rheumatologist in April 2014 and after some blood tests, clinical examinations and x-rays, I was diagnosed with palindromic rheumatism which is closely related to rheumatoid arthritis but is more rare.

My PR symptoms included:
- Painful, stiff and swollen joints
- The joints were red and a little warm to touch
- A persistent feeling of tiredness and fatigue
- Overall muscle ache
- Hair loss
- Rashes
- Brittle nails

My blood tests also showed low levels of Vitamin D and Iron and I was prescribed supplements to bring these back to normal.

The diagnosis of PR is difficult because there is no specific test for it. When you have a PR attack then the blood tests may show raised levels of ESR or CRP. Between flare-ups your tests will appear normal and clinical examination also may not help. Because it is rare, not much research has been done on the condition and it is still not known what triggers this condition.  My x-rays also showed signs of periarticular osteopenia - 'osteopenia' refers to low bone density while 'periarticular' means around the joints. This was noticed in the x-rays of my hands and the rheumatologist thinks it could be a sign of early inflammatory arthritis. I am now being monitored every few months to see if there are any changes in my joints.

The PR started in my right hand but then gradually moved onto my feet - my toe joints have been affected. I also have stiffness and pain in the right wrist. Once the inflammation sets in it usually lasts for days or weeks before gradually subsiding on its own. I have periods of flare-ups when there is severe inflammation and pain and then there are periods where the pain is less. Since the onset of PR I have been waking up with stiff joints every single day. I now maintain a health diary noting down details of my PR episodes and any other health symptoms I have. Like I mentioned earlier not all people with PR develop RA but some may progress to RA. So, it is very important to keep a journal of health symptoms so that your doctor can evaluate your condition better.

In my next post on PR, I will talk about the treatment options available and what you can do to help yourself if you have palindromic rheumatism.

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