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Palindromic Rheumatism — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisPalindromic RheumatismSCE Rheumatology

A 45-year-old woman has a 9-month history of abrupt attacks of painful swelling affecting both wrists and several MCP joints. Synovitis has been documented during an attack. Each episode lasts 24–48 hours and resolves completely; between attacks she is asymptomatic and repeated examination shows no synovitis. Hand and wrist radiographs show no erosions. Rheumatoid factor and anti-CCP antibodies are positive. What is the most likely current diagnosis?

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Correct answer: A — Palindromic rheumatism

Palindromic rheumatism is the best diagnosis. The decisive pattern is recurrent, abrupt, short-lived attacks of objective synovitis with complete symptom- and sign-free intervals and no erosive damage. RF and anti-CCP can be positive in palindromic rheumatism and indicate an increased risk of later persistent rheumatoid arthritis, but they do not override the episodic phenotype. Established RA causes persistent inflammatory arthritis rather than repeatedly resolving 24–48-hour attacks. CPP crystal arthritis can involve the wrists and MCP joints but is less consistent with this repeated symmetric pattern at age 45 and would require crystal evidence. Parvovirus arthritis is usually a single self-limiting illness, whereas reactive arthritis typically causes asymmetric lower-limb oligoarthritis following infection.

Reference: Mankia K, Emery P. Palindromic rheumatism as part of the rheumatoid arthritis continuum. Nature Reviews Rheumatology. 2019;15:687–695. https://pubmed.ncbi.nlm.nih.gov/31595059/