Nobody knows for sure, but the more you learn, the weirder it seems. Here is a type of RA which you may not know about. It is rarer than the four general courses of Rheumatoid Arthritis which are in our cute chart.
The word “palindromic” comes from two Greek words. (Believe It Or Not: I do read Greek, well ancient Koine Greek anyway. And I do still use a lexicon to help me. Well, back to our program…) Palin is from a word that means again. And, dromos is from a word that means run. So a palindrome runs both ways, like the words “ewe” and “eye.”
Palindromic Rheumatism (PR) or Palindromic RA starts and stops spontaneously. It is a periodic arthritis. It can affect a few joints or a single joint at a time. It usually last only a few days.
The remission period is unpredictable. So the time between attacks varies. However, flares can become more frequent over time.
How is Palindromic Rheumatism like regular Rheumatoid Arthritis?
They are similar in symptoms:
There is pain, inflammation, and disability when a joint is affected. There is of course no known cause or cure. Typically, it affects adults between the ages of 20 and 50. Intriguingly, people with PR often fail the same tests as people with RA – blood tests, that is. The anti-CCP test, the Rheumatoid factor test, and the ESR or sed rate are all used to indicate either RA or PR. However, these blood tests can also be negative in both of these forms of arthritis.
They are similar in treatment:
Palindromic Rheumatism is usually treated with both NSAIDS and steroids (often by injection since few joints are involved). Sometimes DMARDs are prescribed for PA also.
How is Palindromic Rheumatism different from regular Rheumatoid Arthritis?
The most significant difference between Rheumatoid Arthritis and Palindromic Rheumatism is that PR does not usually cause any permanent damage to joints. In part, Palindromic Rheumatism is diagnosed by the absence of radiographic changes (X-rays often give evidence of RA.) And unlike RA, PR is an equal opportunity offender: it attacks both genders equally.
Is Palindromic Rheumatism related to regular Rheumatoid Arthritis?
Maybe. About half of the time, people who have Palindromic Rheumatism develop what I call “full blown” RA. Some doctors have speculated about why tests which are quite specific for Rheumatoid Arthritis also correlate with Palindromic Rheumatism. One theory which I have come across, more than once, is that PR is actually an abortive form of RA. In fact, many who have PR actually take DMARDs in hope of forestalling the onset of RA.
More questions about Palindromic Rheumatism?
Johns Hopkins has a detailed article on PR.
Rissa, the author of the wonderful RA poem, has a new PR group.
In Britain, there is a PR society with some good information about PR.
NOTE: The more I learn, the more obvious it is to me that this disease is one unruly character in all its forms. Thank God we are living in a time when we can be so linked up to one another. Coming soon at R A W: a surprising account from American history.