Prognostic Factors in Palindromic Rheumatism

Thirty-eight patients with palindromic rheumatism were reviewed. A questionnaire was compiled to elucidate prognostic factors in the pattern of disease. Over the period of follow-up 6 patients had developed rheumatoid arthritis, 25 remained palindromic, 3 were in remission of symptoms for over a year, 1 developed ankylosing spondylitis, 1 systemic lupus erythematosus and 2 a non-specific polyarthritis. The duration and interval between attacks was variable and did not differ significantly between the palindromic and rheumatoid groups. All patients who developed rheumatoid had a combination of morning stiffness and pain in several joints at once, whereas only 28% of the palindromics did so, (p <0.01). There was a tendency for episodes of joint pain to occur with increasing frequency and for the plasma viscosity to be persistently elevated in those who developed rheumatoid arthritis. Neither a family history of rheumatoid arthritis nor a positive serum rheumatoid factor test at presentation were of prognostic significance. Oral analgesics or symptomatic measures for the relief of joint pain were effective in the majority of patients.