Letter to the Editor

Palindromic Rheumatism: Strategies to Prevent Evolution to Rheumatoid Arthritis

Authors: Rtika R. Abraham, MD

Abstract

To the Editor:


The article by Iyer et al1 provides an informative overview about palindromic rheumatism (PR), which is a rare entity, but it is critical that primary care physicians recognize not only the disabling nature of the acute fleeting joint pains patients experience but also the burden of rheumatoid arthritis (RA) that it carries.2 Anti-citrullinated protein antibody (anti-CCP) was found in a high proportion of patients with PR, suggesting that this syndrome is an abortive form of RA; however, the predictive value of these antibodies in PR as markers of progression to established RA remains uncertain.3 A Korean study noted the increased frequent finding of the HLA-DRB1 allele *803 in PR.4Maksymowych et al described a significant dose effect of shared epitope alleles in determining the risk of progression from PR to RA.5

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References

1. Iyer VR, Cohen GL. Palindromic rheumatism. South Med J 2011; 104: 147–149.
 
2. Koskinen E, Hannonen P, Sokka T. Palindromic rheumatism: long-term outcomes of 60 patients diagnosed in 1967–84. J Rheumatol 2009; 36: 1873–1875.
 
3. Salvador G, Gomez A, Vinas O, et al. Prevalence and clinical significance of anti-cyclic citrullinated peptide and antikeratin antibodies in palindromic rheumatism. An abortive form of rheumatoid arthritis? Rheumatology 2003; 42: 972–975.
 
4. Kim SK, Lee HS, Lee KW, et al. Palindromic rheumatism: different genetic background implies a distinct clinical entity. Ann Rheum Dis 2006; 65: 1539–1540.
 
5. Maksymowych WP, Suarez-Almazor ME, Buenviaje H, et al. HLA and cytokine gene polymorphisms in relation to occurrence of palindromic rheumatism and its progression to rheumatoid arthritis. J Rheumatol 2002; 29: 2319–2326.
 
6. Youssef W, Yan A, Russell AS. Palindromic rheumatism. A response to chloroquine. J Rheumatol 1991; 18: 35–37.
 
7. Gonzalez-Lopez L, Gamez-Nava I, Jhangri G, et al. Decreased progression to rheumatoid arthritis or other connective tissue diseases in patients with palindromic rheumatism treated with antimalarials. J Rheumatol 2000; 27: 41–46.
 
8. Avina-Zubieta J, Galindo-Rodriguez G, Newman S, et al. Long term effectiveness of antimalarial drugs in rheumatic diseases. Ann Rheum Dis 1998; 57: 582–587.
 
9. Chen HH, Chen DY, Hsieh TY, et al. Predicting the progression of palindromic rheumatism to rheumatoid arthritis: the role of ultrasonography and anti-cyclic citrullinated peptide antibodies. J Med Ultrasound 2010; 18: 17–26.