Palindromic rheumatism
A pattern of sudden, recurring attacks of joint inflammation that come and go, sometimes a forerunner of rheumatoid arthritis
Palindromic rheumatism is a condition in which joint inflammation comes on suddenly in attacks, lasts from hours to a few days, and then settles completely, often with no symptoms in between. The attacks recur over time. In some people it can eventually develop into rheumatoid arthritis, which is one reason assessment and monitoring are worthwhile.
Written for patients and reviewed by Dr Liubov Borukhson, Consultant Rheumatologist (GMC 7021928). Last clinically reviewed: June 2026.
Common symptoms
Palindromic rheumatism has a distinctive on-off pattern. Features may include:
- Sudden attacks of pain, swelling and stiffness, often in one or a few joints
- Attacks that last from a few hours to a few days, then settle fully
- Periods of feeling completely well between attacks
- Sometimes swelling of the soft tissues around a joint
Palindromic rheumatism affects the joints and the soft tissues around them, and it does not usually cause a rash. If a rash comes with your attacks, that can be a useful clue pointing towards a different or additional diagnosis, such as lupus or psoriatic arthritis, and is worth mentioning to your specialist.
What can trigger an attack
Attacks often arrive without warning, and for many people there is no clear trigger. Some notice that an attack tends to follow physical exertion, a period of stress, or a minor infection, and occasionally a particular food is suspected, but these patterns are individual and not consistent from person to person. Keeping a short diary of when attacks happen, which joints are affected and how long they last can help you and your specialist spot any pattern and build an accurate picture of the condition over time.
How it is diagnosed
Because the joints can look and feel normal between attacks, diagnosis relies heavily on the history of the pattern, supported by an examination and blood tests, including antibodies that can indicate a higher chance of progressing to rheumatoid arthritis. Capturing the picture accurately helps guide treatment and monitoring.
There is no single test that confirms the diagnosis; it is recognised from this characteristic pattern of recurrent, fully self-limiting attacks, once other causes have been excluded. Blood tests for rheumatoid factor and anti-CCP antibodies are checked routinely, as a positive result raises the likelihood of later progression to rheumatoid arthritis and influences how closely you are monitored.
If an attack can be assessed while it is active, ultrasound can confirm the inflammation. Dr Borukhson uses point-of-care ultrasound during the consultation. You can read more on the ultrasound clinic page.
How it is treated
Treatment aims to settle attacks and reduce how often they happen, and in some people to lower the chance of progression to a persistent arthritis. The approach is individual and kept under review, as the right plan depends on the frequency of attacks and the results of any tests. It is always discussed with you.
An individual attack is often eased with an anti-inflammatory medicine (an NSAID). Where attacks are frequent, a disease-modifying medicine is commonly added to reduce how often they occur: hydroxychloroquine is the usual first choice, and there is evidence it may also lower the chance of progressing to rheumatoid arthritis, particularly when antibody tests are positive. Other DMARDs, such as sulfasalazine, are sometimes used instead or alongside it.
Why assessment and monitoring matter
Because palindromic rheumatism can sometimes be an early stage on the way to rheumatoid arthritis, assessment, monitoring and timely treatment can make a real difference. If you have recurring attacks of joint pain and swelling that come and go, a specialist review is worthwhile.
Recurring attacks of joint pain that come and go?
A specialist assessment can confirm palindromic rheumatism, guide treatment, and monitor for any progression over time
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