Treatment of So-called Palindromic Rheumatism with Gold Compounds

Abstract

A relatively rare form of arthritis was described by Hench andRosenberg in 1941 andin 1944. The syndrome is characterized by frequently recurring attacks of pain, swelling, redness, and disability involving usually one joint at a time, but sometimes multiple joints. The attacks last for short periods and then subside completely without leaving -joint residue. They considered it to be a " new disease ", an entity separate from rheumatoid arthritis and distinguishable clinically from other forms of recurring acute arthritis. To this syndrome the name " palindromic rheumatism " was applied.From an analysis of their thirty-four cases, Hench and Rosenberg outlined the clinical characteristics of palindromic rheumatism. In summary, these were as follows: (1) multiple afebrile attacks of acute arthritis characterized by pain, swelling, tendemess, varying degrees of redness, and increased local heat; (2) frequent recurrences (88 per cent. of cases averaging twenty-three attacks per year) at irregular intervals (few hours to two weeks in most cases); (3) attacks of short duration (80 per cent. lasting a few hours to three days); (4) attacks usually affecting a single joint (90 per cent. of cases); (5) disability often considerable with temporary loss of function of the involved part; (6) complete restitution of joint appearance and function following attacks; (7) para-arthritis, consisting of red tender swellings near a joint (30 per cent. of cases), and frequent involvement of finger pads; (8) absence of general constitutional signs and symptoms; (9) absence ofchronic arthritis even when the disease has persisted for years; (10) intracutaneous or subcutaneous nodules (9 per cent. of cases); (11) essentially normal laboratory tests including erythrocyte sedimentation rates, blood uric acid determinations, and radiographs of involved joints; (12) adults of either sex affected equally. Joint biopsies were accomplished in three instances (two during acute attacks and one after recovery); these disclosed subacute cellular reactions in the synovial membrane during attacks, but the cellular condition returned to normal on recovery.

Treatment of palindromic rheumatism: A systematic review

“…In one of the first reports in which gold was used in the treatment of PR, three patients with PR were evaluated 29 . A noticeable reduction in the frequency and severity of attacks happened in all of the patients in total doses of 375‐625 mg. Remission occurred in total doses of 575‐1175 mg. None of the patients developed radiographic changes or persistent arthritis during 6‐18‐month follow‐up.…”

“…In a case series with three patients and in two case reports, no beneficial effect of colchicine in reducing attacks was reported. [29][30][31] Schwartzberg et al reported complete cessation of attacks in two and decreasing the duration and frequency of attacks in three of five patients with PR treated with colchicine (1-2 mg/d). 32 Diarrhoea was developed in two patients.…”

A short history of anti-rheumatic therapy - VI. Rheumatoid arthritis drugs

“…Tra l'altro, questo studio era stato disegnato fin dal 1937 (11), ma fu poi interrotto per lo scoppio della seconda guerra mondiale, anche se già nel 1945 lo scozzese Thomas N. Fraser (18) pubblicò i primi risultati parziali. L'indicazione fondamentale dei sali d'oro rimane l'AR, anche se risultati soddisfacenti sono stati poi ottenuti nell'artrite psoriasica (19), nei reumatismi cronici dell'infanzia (20) e nel reumatismo palindromico (21). Allontanandoci per un attimo dall'ordine cronologico, è opportuno accennare a questo punto all'auranofin, che è pur sempre un sale d'oro, ma che, a differenza dai sali d'oro tradizionali, è attivo per via orale.…”