In palindromic rheumatism, hand joint involvement and positive anti-CCP antibodies predict RA development after 1 year of follow-up

Abstract

This study aimed to determine the frequency of rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibodies in a cohort of patients with palindromic rheumatism (PR) and to find determinants for progression to rheumatoid arthritis (RA). All new cases of PR (n=90) were included prospectively and followed up for 1 year, and a comparison group of RA cases (n=70) was also included. At study entry in all patients in both groups, RF and anti-CCP antibodies were tested, and the findings were compared and correlated. In the PR group at presentation, RF was positive in 30 patients (33.3%) and, in the RA group, in 45 patients (64.3%). Anti-CCP antibodies were positive in 35 patients (38.9%) with PR and in 58 patients (82.9%) with RA. In the PR group, positive correlations were observed between RF and C-reactive protein (CRP) (p=0.036), while anti-CCP positively correlated with disease duration (p=0.015) and CRP (p<0.001). At 1-year follow-up, 25 cases (27.5%) had progressed to RA, 3 (3.3%) cases had developed systemic lupus, 43 cases had responded to hydroxychloroquine with complete remission, five cases had developed other rheumatic diseases, and 14 cases had progressed to undifferentiated arthritis. After regression analysis, the involvement of hand joints and positive anti-CCP were the only predictors that determined progression into RA within a year (p<0.001 and p=0.02, respectively). Early hand joint involvement and positive anti-CCP at disease onset are good predictors for progression to RA in this domain.

Identification of a distinct imaging phenotype may improve the management of palindromic rheumatism

“…PR is characterised by intermittent flares of articular and periarticular inflammation. Up to 50% of patients with PR will eventually develop rheumatoid arthritis (RA), with those that are anticyclic citrullinated peptide (CCP) antibody positive at highest risk of progression 2–4. However, the time to progression is variable and many anti-CCP positive patients with PR do not develop persistent arthritis, even after several years of follow-up 5.…”

Palindromic Rheumatism Frequently Precedes Early Rheumatoid Arthritis: Results From an Incident Cohort

“…Few studies have quantified patient symptoms preceding ERA diagnosis or characterized PR preceding ERA . The strengths of this study are its unique quantitative characterization of episodic inflammatory symptoms prior to ERA and inclusion of ERA patients from multiple centers.…”

“…Palindromic rheumatism (PR) constitutes transient acute attacks of self‐resolving articular and/or periarticular inflammation without radiographic damage . Although it is debated whether PR is part of the spectrum of rheumatoid arthritis (RA), estimated rates of PR progression to RA range from 50% to 67%, and PR is widely considered an at‐risk phenotype for development of RA .…”

Palindromic rheumatism as part of the rheumatoid arthritis continuum

“…In a cross-sectional analysis of a Spanish PR cohort, the frequency of anti-CCP antibodies was similar in PR compared with early RA patients (53% vs 55% respectively) (6). Other international PR cohorts report similarly high frequencies of anti-CCP positivity (between 46% and 68%) (7)(8)(9)(10)(11). A notable outlier is a recently described Taiwanese PR cohort where only 11/84 (13%) of patients were anti-CCP positive and 12/84 (14%) were RF positive (12).…”

“…PR and RA have a predilection for the same joints. Studies of different PR cohorts have consistently reported the wrists, metacarpophalangeal joints (MCPJs) and proximal interphalangeal joints (PIPJs) as the most commonly affected sites in PR (2,4,8,9,19,20). In contrast, the spine and sternoclavicular joints are the least frequently affected sites (mean 4% and 2% of patients respectively) (19).…”