Palindromic rheumatism — SCE Rheumatology MCQ

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ModerateInflammatory ArthritisPalindromic rheumatismSCE Rheumatology

A 39-year-old woman describes sudden attacks of swelling in one or two MCP joints, each lasting 24–48 hours and resolving completely. Between attacks examination is normal. RF and anti-CCP are positive, CRP is normal between episodes and hand radiographs show no erosions. She has no psoriasis or bowel symptoms. What is the most likely diagnosis?

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Correct answer: A — Palindromic rheumatism

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as E

Palindromic rheumatism is best because brief recurrent self-resolving attacks with normal intercritical examination are typical of palindromic rheumatism, especially with anti-CCP positivity. A is less suitable because reactive arthritis follows infection and persists longer with enthesitis or urethritis; B is less suitable because established RA usually causes persistent synovitis; C is less suitable because psoriatic arthritis would be supported by psoriasis, nail changes or dactylitis; D is less suitable because gout commonly affects the first MTP and crystal confirmation would be expected. Clinical pearl: anti-CCP positivity in palindromic rheumatism predicts progression to RA.

Reference: Oxford Textbook of Rheumatology; NICE NG100