Oral Presentation Australian Podiatry Conference 2019

Palindromic rheumatism: Can arthritis that comes and goes hold the key to understanding RA? (#38)

Anne-Maree Keenan 1 2 , Kulveer Mankia 1 2 , Paul Emery 1 2
  1. Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
  2. NIHR Leeds Biomedical Research Centre , Leeds Teaching Hospitals Trust, Leeds, United Kingdom

Palindromic rheumatism (PR) a diagnostic label applied to episodes of self-limiting clinical arthritis, occasionally with skin disease.  Symptoms are sudden onset of joint swelling which develops rapidly, lasts for a few hours or days then disappears.  Attacks are usually mono-articular but with the site of joint pain often changing with each episode.  While symptoms may affect any joint in the body with wrists, knees, shoulders, feet and ankles (in order of frequency) are most susceptible.  Of note, almost half of patients with PR later develop rheumatoid arthritis (RA):  understanding these patients may hold the key to understanding triggers for RA.  Treatment for PR varies, but is generally centred on reducing inflammation and pain.  The clinical appearance, differential diagnosis and imaging appearance is important for podiatrists to identify PR and refer on for early treatment

This presentation will also present initial findings from our Birmingham-Leeds collaboration.  With colleagues at Birmingham, we have identified the substantial patient burden of PR: patients experience a wide range of physical symptoms and report psychological and emotional distress, frequently exacerbated by a lack of information and the apparent therapeutic and prognostic uncertainty.  Early results from imaging studies at Leeds has indicated for the first time that active PR demonstrated greater peri-articular soft tissue inflammation compared to active synovitis that is seen with RA, potentially explaining the difference in clinical symptoms.