[Palindromic rheumatism--progression to erosive rheumatoid arthritis--presentation of 3 years treatment of a patient]

Abstract

The 3-year course of treatment of a 35-year old male patient presenting with recurrent afebrile episodes of acute mono- or polyarthritis, periarthritis and at times paraarthritis of the left ankle and knee joint as well as the PIP and MCP joints of the hands is presented. The episodes lasted from a few hours up to several days, leaving no residual changes in the joints. After initial observation and treatment, palindromic rheumatism was diagnosed. During the second year of treatment, seroconversion from the rheumatoid factor negative to the rheumatoid factor positive arthritis form was established. In the third year of treatment, erosions of cartilage and bone in the left knee joint were confirmed radiologically. On the basis of the clinical picture, laboratory findings and radiologic changes in the joints, the diagnosis of erosive seropositive rheumatoid arthritis was made. The author stresses that the diagnosis "palindromic rheumatism" could be established sooner and more often, particularly if, regarding the typical clinical course and history, the possibility of this disease were taken into consideration at all.