Palindromic rheumatism flare self-management

About palindromic rheumatism

Palindromic rheumatism is a form of inflammatory arthritis (sometimes called palindromic arthritis). It causes flares (attacks) of joint pain and inflammation that come and go. The joints look and feel normal between flares.

Symptoms

People with palindromic rheumatism usually have no symptoms between flares. This is different from other types of inflammatory arthritis, such as rheumatoid arthritis, which cause joint problems most of the time.

About flares

• During a palindromic rheumatism flare, the joints involved, and the tendons and area around them, feel painful and stiff. They may also look swollen, feel tender and hot, and the skin over the joints may look red.
• Flares usually start in 1 or 2 joints. They often affect the hands, which quickly become painful, stiff and swollen.
• Flares can move from joint to joint.  Some flares last just a few hours, while some last for several days.
• Eventually the flare stops, and joints and tendons return to normal.
• Palindromic rheumatism doesn’t usually affect other parts of the body. However, some people also have a fever during a flare, or develop nodules under the skin, near the affected joints.
• Some people feel tired after a flare. This is known as fatigue. It can last for a few days or weeks and might affect you physically. It can also affect your concentration and motivation.
• Flares come and go and the pattern of flares – how often they happen, how long they last and which joints they involve – is different for everyone. Some people experience 1 attack a year, while others have more than 1 a week.

Flare self-management

When your pain is particularly bad, we advise you to rest your joints. You might find wrist splints and insoles for your shoes helpful.

Heat or cold

Applying heat or cold to your joints may reduce pain and inflammation. For example, hot or cold showers, a hot water bottle, wheat bag or heating pad, or an ice pack, bag of frozen peas or cold gel.

• Always place a towel between your skin and the source of heat or cold to prevent skin damage.
• Alternate between using hot and cold for 15 minutes at a time.
• Do not use heat or cold on psoriasis skin patches.

Once the inflammation has settled down, it is a good idea get moving again by doing gentle exercise

Movement

Keeping moving is one of the best ways to limit the duration and intensity of your flare.

Try to go out for a short walk, even if it is just to the front gate.

Natural daylight helps to lift the mood by releasing endorphins (chemicals naturally produced by the body). These, in turn, help people cope with pain.

Gently stretch the areas that tend to tighten up with your arthritis, even if this feels uncomfortable. Stop if you begin to feel intense pain. 

Treatment

We use medicines as the main treatment to reduce pain and inflammation during palindromic rheumatism flares.

NSAIDs (non-steroidal anti-inflammatory drugs)

These drugs block inflammation and help reduce flare symptoms.

NSAIDs are not a long-lasting fix and you may have to take them regularly.

Some NSAIDs can affect the stomach, so you may need to take omeprazole as well, to reduce the amount of acid your stomach makes.  You GP can advise you.

Pain medicines

These drugs may not help to remove inflammation, but they can help with overall discomfort.

Steroids

Steroids may be an option if your symptoms are severe or long-lasting and NSAIDs and pain medicines do not help.

You can take steroids by mouth or by injection.   

Your GP may recommend you have a blood test first, to confirm the level of inflammation and indicate whether steroids are the right treatment for you.

DMARDs (disease-modifying anti-rheumatic drugs)

If your flares become more frequent, your GP may recommend a DMARD to treat your condition long-term, rather than reducing the symptoms of an occasional flare.

Your GP will take into account the frequency and severity of your flares. They are likely to suggest a blood test to confirm that DMARDs are a suitable treatment for you.

When to seek further help

Contact your GP or rheumatology team if you notice that your attacks are becoming more frequent or there is a change in the severity of your symptoms.  They may decide to review your medicines.