Palindromic rheumatism: From pathogenesis to clinical presentation — An updated review

Palindromic rheumatism (PR) is referred to as recurrent and transient attacks of arthritis/periarthritis that last from a few hours to a few days and resolve spontaneously. The duration of attacks varies from ۲ hours to ۲ weeks, but they last an average of two days. During attacks, fever and other systemic symptoms are rare, and the patient is asymptomatic between attacks. It has been reported that ۲.۵% of people with musculoskeletal complaints had PR. Although the pathogenesis of PR is not precisely known, there is a large body of evidence that strongly suggests a role for immune dysregulation, genetic predisposition and environmental factors. Due to evidence of immunological imbalance in the PR, many authors consider PR to fall within the spectrum of autoimmune diseases. This view is supported by the close association with rheumatoid arthritis (RA) especially the presence of RA-related autoantibodies in the majority of PR patients, the predilection for the involvement of small joints of hand in PR and the high rate of progression to RA among these patients, and increased frequency of HLA-DR related shared epitope in PR. Autoantibodies related to RA, including rheumatoid factor and anti-citrullinated peptide antibodies, are commonly seen in patients with PR. However, a possible role of autoinflammation has been suggested in view of the relapsing/ remitting course of PR that resemble those observed in autoinflammatory disease, such as familial Mediterranean fever. MEFV mutations have been observed in ۱۲% of PR patients.

کلیدواژه ها:

palindromic rheumatism ، Rheumatoid arthritis ، autoimmunity ، autoinflammation ، immune dysregulation ، genetic factors