What is palindromic rheumatism? By Aaron Kandola

Palindromic rheumatism is a rare form of arthritis that causes symptoms to flare up periodically and then disappear, leaving no lasting damage to the joints.

Palindromic rheumatism is a form of inflammatory arthritis. This means that it causes inflammation, pain, and swelling around the affected joints.

In this article, we take a close look at palindromic rheumatism, examining its causes, symptoms, and outlook.

What is palindromic rheumatism?

Unlike other forms of arthritis, the symptoms of palindromic arthritis come and go without leaving permanent damage in the joints. The pain may come and go suddenly and can arise in different joints.

In the English language, 'palindrome' means a word that is spelled the same both backward and forward.

Hence, palindromic rheumatism attacks tend to begin and end with the same mild symptoms. The symptoms peak in the middle of the attack.

Palindromic arthritis affects men and women equally and can affect people of any age. It is most common in people between the ages of 20 and 50 years old.

About 50 percent of people with palindromic rheumatism eventually develop rheumatoid arthritis (RA).

Differences between palindromic rheumatism and arthritis

Palindromic rheumatism and RA are both autoimmune disorders. However, they have different effects on the body.

In other forms of arthritis, the tissues in the joints are worn down over time, causing inflammation, pain, and stiffness.

Palindromic rheumatism causes the same symptoms, but, the affected joints return to normal in between attacks. Unlike other forms of arthritis, attacks do not cause lasting damage to the joints.

Symptoms of palindromic rheumatism

The symptoms of palindromic rheumatism usually start in one joint but can spread to others.

The attacks can last several hours or days. Some people will experience attacks daily, whereas others may only experience them a few times a year. People may notice a pattern in the frequency of their attacks.

The symptoms of palindromic rheumatism during attacks include:

• swelling and redness in one or more joints
• stiffness in affected joints
• swelling and soreness in the tendons or other tissue around the joints
• fatigue
• restricted mobility
• a low-grade fever

People will not usually experience symptoms between attacks.

The condition does not cause permanent joint damage, but people with palindromic rheumatism can develop more severe forms of arthritis, which may then cause lasting joint damage.

Diagnosis

Diagnosing palindromic rheumatism can be difficult, as it is a rare condition. Doctors may recommend multiple tests before confirming a diagnosis to rule out more common forms of arthritis first, as the symptoms can be very similar.

There is no specific test for the condition, so doctors usually diagnose palindromic rheumatism based on symptoms.

Diagnosis will include an assessment of medical history and a physical examination. A doctor will assess the physical symptoms and may test the mobility of any affected joints.

A diagnosis may also involve imaging tests such as an X-ray. This can help to determine the location and severity of the damage caused by the condition.

Doctors may also use blood tests to test for antibodies and the presence of an infection.

Causes of palindromic rheumatism

Palindromic rheumatism is rare, and researchers do not yet fully understand the condition, including what causes it. It may be that inflammatory cells move along the lining of the joint, producing the inflammatory reaction.

Palindromic rheumatism could involve the following factors or triggers:

• genetics or family history
• trauma
• infections
• allergic reactions

• Treatment

  There is no cure for palindromic rheumatism at the moment, but certain treatments and lifestyle changes can improve people's symptoms, reduce the severity of attacks, and improve quality of life.
  Treatments include the following:

  Lifestyle changes

  

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As with any form of arthritis, people can make some lifestyle changes to manage their symptoms.

Regularly exercising is essential for keeping joints healthy. Rheumatism can restrict mobility and make movement uncomfortable. Nevertheless, inactivity can cause the surrounding muscles to break down, and damage the affected joint itself.

Stretches and exercises that promote flexibility, range-of-motion, and muscle strength around the affected joints can reduce the severity of attacks, as the joints will move more easily and have more support.

People should discuss an exercise plan with a doctor or physical therapist. This is vital, so they ensure it is set at the right intensity and does not include any exercises that put too much stress on the affected joints.

Maintaining a healthy weight can also help reduce symptoms. Being overweight can put additional strain on joints, which can make symptoms worse. A regular diet and exercise routine can help.

Medication

Medications can be beneficial when a person is trying to manage their symptoms and slow down the progression of arthritis. These include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), taken regularly, can control inflammation and reduce discomfort and joint stiffness.
• Disease-modifying anti-rheumatic drugs (DMARDs) can be prescribed by a doctor to reduce the frequency and severity of attacks.

Doctors usually prescribe DMARDs when inflammation is severe and long-lasting. They are slower acting than NSAIDs and have more side effects.

People should note that DMARDS are immunosuppressants, meaning they suppress the immune system, and a person may be more likely to develop infections.

Steroid injections

In rare cases, a doctor can inject steroids into the joint to reduce inflammation immediately. They may recommend this when the joint or tendon has become extremely inflamed and is causing significant discomfort.

Outlook

Palindromic rheumatism is not associated with any critical health risks.

According to Arthritis Research UK, the outlook for palindromic arthritis is as follows:

• around 10 to 15 percent of people will see their symptoms disappear
• around 30 to 50 percent will have only occasional attacks
• between 30 and 40 percent will experience problems that worsen

Palindromic arthritis can cause severe discomfort, particularly if the attacks are frequent or lasting. In some people, it can lead to conditions such as rheumatoid arthritis, which can cause permanent damage to joints.

Blocking this protein may keep obesity, diabetes at bay By Catharine Paddock PhD

Blocking a protein in the liver can prevent obesity and its related diseases — such as type 2 diabetes and fatty liver — in mice, according to new research.

A study by Cincinnati Children's Hospital Medical Center in Ohio reveals that a protein called Argonaute 2 (AGO2) controls how energy is made and used in the liver.

It does this by silencing RNA, a molecule that carries genetic instructions held in the DNA blueprints in the cell's nucleus to the cell's protein-making machinery.

The scientists revealed that, by silencing RNA, AGO2 slows metabolism in the liver and the organ's "ability to process a high-fat diet."

However, when they deleted AGO2 in the livers of mice on a high-fat diet, the mice did not become obese and did not develop type 2 diabetes and fatty liver disease.

Fatty liver disease — or, more accurately, nonalcoholic fatty liver disease — is a condition in which fat builds up in the liver. It can severely harm the organ, whose main job is to clean and detoxify blood.

Vicious cycle in disrupted energy metabolism

The findings suggest that RNA silencing by AGO2 links two important processes: control of energy supply, and the production of proteins inside cells.

"This mechanism," note the investigators in a recently published Nature Communications paper on their work, "may be the core of a vicious cycle in disrupted energy metabolism in the obese liver."

The team identified AGO2 after screening and analyzing the behavior of genes and the associated proteins that they target in the liver.

They examined the effect of deleting proteins that play a key role in liver metabolism in normal and genetically engineered mice that were fed on high-fat diets.

Senior study author Takahisa Nakamura, an assistant professor in the Department of Pediatrics at Cincinnati Children's Hospital, warns that the science is "still basic," and that it is too early to say how it might translate into new treatments.

There might be important implications, however, for the treatment of "chronic metabolic disorders like diabetes, fatty liver diseases, and other obesity-associated illnesses," he notes.

What they have achieved so far, Nakamura suggests, should help them search for potential new treatments that target obesity and associated diseases by altering energy balance in the liver.

Further work will involve the confirmation of these findings in "laboratory models" and the development of an experimental AGO2 blocker for clinical testing in humans.

The obesity epidemic and calorie imbalance

Obesity is a global public health problem that has reached epidemic proportions. Most people in the world now live in countries where carrying too much weight is more fatal than being underweight.

The issue has arisen due to a calorie imbalance; we are consuming more — but burning fewer — calories now than we did a few decades ago.

The main reason that we are taking in more calories is because there has been a worldwide increase in consumption of energy-dense foods — particularly those that are high in fat.

Also, we are burning fewer calories because we move and exert ourselves much less than our forefathers did; we increasingly use motorized transport and have more sedentary jobs and lifestyles.

The consequence of this is an increase in many obesity-related diseases, such as heart disease, stroke, type 2 diabetes, some cancers, and fatty liver.

The results of the new study suggest that one way to tackle this could be to alter metabolism in people's livers, as the liver is a "major organ for energy consumption."

The study focuses on protein production in cells, which is one of the processes in the liver that needs a lot of energy. This accounts for up to 30 percent of energy used in the liver.