Background/Purpose Palindromic rheumatism (PR) is a clinical syndrome characterised by episodes of joint swelling that settle spontaneously.  A proportion of patients with PR progress and develop rheumatoid arthritis (RA). Understanding the factors associated with progression would have value for management and understanding pathogenesis. We therefore identified potential factors associated with the development of RA in these patients.

Methods A retrospective analysis was done on 55 patients with PR followed up in our rheumatology early arthritis clinics. For inclusion, patients had either a history or physical examination findings consistent with synovial swelling that returned to normal between episodes in the absence of an alternative diagnosis. Medical history, clinical examination and laboratory findings were compared between the group that progressed to ACR/EULAR 2010 RA (progression) and the group that did not (non-progression). Comparisons between groups were made with Mann-Whitney U tests or Pearson’s chi-square tests, according to data type.

Results Of the 55 patients, 28 (51%) developed RA and 27 (49%) did not over a mean (SD) period of 28.3 (40.0) and 17.2 (19.0) months of follow-up. Factors that differed between the groups were: age at PR onset (non-progression vs. progression median 39 vs. 48 years; table), duration of interval between attacks (30 vs. 45 days), anti-cyclic citrullinated peptide (anti-CCP) positivity (96% vs. 73%), and anti-CCP titre (164 vs. 57 U/ml).

Conclusion In our cohort of patients with PR, a relatively high proportion progressed to RA. Features on history and anti-CCP anti-body positivity, particularly high antibody titres, were found to be associated with evolution to RA. These data should be of value in managing therapy and follow-up of PR patients.

Table. Characteristics of patients with palindromic rheumatism who progressed to RA in comparison with those without progression to RA at the first visit.
Characteristics	Non-progression	Progression	OR (95% CI)	p
Number (%)	27 (49)	28 (51)
Age, yrs	39 (32, 45)	48 (39, 59)		0.009*
Female, no. (%)	17 (63)	19 (68)	1.2 (0.4-3.8)	0.703
Symptom durationa, wks	57.0 (28.0, 108.5)	86.0 (36.0, 138.0)		0.418
Followup, mo	9.0 (2.0, 22.0)	16.0 (10.3, 29.8)		0.107
Duration of one attack, hours	60.0 (30.0, 60.0)	36.0 (33.0, 51.0)		0.356
Interval of attacks, days	45.0 (30.0, 90.0)	30.0 (12.3, 30.3)		0.007*
Gout crystal arthropathy, no. (%)	0 (0)	4 (14)	1.2 (1.0-1.4)	0.041
Smoker (current or previous), no. (%)	16 (59)	22 (79)	2.5 (0.8-8.2)	0.121
Smoker (current), no. (%)	8 (30)	10 (36)	1.3 (0.4-4.1)	0.631
FDRRA, no. (%)	9 (33)	5 (18)	0.4 (0.1-1.5)	0.188
RF +, no. (%)	13 (57)	15 (68)	1.6 (0.5-5.6)	0.420
Anti-CCP +, no. (%)	16 (73)	24 (96)	9.0 (1.0-82.0)	0.025*
Anti-CCP titre (U/ml)	57.0 (0.5, 142.9)	164.0 (57.0, 300.0)		0.010*
CRP (mg/l)	4.0 (3.0, 11.7)	4.2 (2.2, 9.3)		0.637
ESR (mm/h)	10.0 (4.0, 22.0)	17.0 (6.0, 32.0)		0.181
ANA +, no. (%)	4 (17)	5 (19)	1.2 (0.3-5.1)	0.814
Data are median (inter-quartile range). RA rheumatoid arthritis, PR palindromic rheumatism, MTX methotrexate, Anti-CCP anti-cyclic citrullinated peptide, FDRRA first degree relative with RA, RF rheumatoid factor, CRP C-reactive protein, ESR erythrocyte sedimentation rate, ANA antinuclear antibodies.

^aPeriod between patient-reported symptom onset and date of first anti-CCP test

*p<0.05

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/in-palindromic-rheumatism-older-age-shorter-interval-between-attacks-and-positive-anti-ccp-antibodies-may-predict-progression-to-ra/