Palindromic rheumatism: effect of dietary manipulation

Evaluation of the contribution of dietary components in triggering the attacks of palindromic rheumatism (PR), and the effect of dietary manipulation on the frequency and severity of PR attacks.

Sixteen patients (10 males, 6 females) were diagnosed as having PR during 1994-8 in one center. Their mean age was 45 +/- 6, duration of symptoms prior to diagnosis was 4 +/- 1.4 years, and frequency of PR attacks were 3.1 +/- 1.8/month. All patients were instructed to make a list of the food that was consumed daily and to specify the dates of PR episodes. Data were evaluated after a period of 2-4 months in each patient.

In 5 patients (31%) there was an association between episodes of PR and certain foods that were consumed within 36 hours prior to PR episodes. These were fish (2 patients), eggs, canned vegetables and processed cheese (each in one case). Elimination of the relevant food from each patient's diet resulted in complete cessation of the PR attacks in two of the cases, while the other three had milder, infrequent attacks. Four patients were rechallenged with the offending food. In all cases it resulted in recurrence of the PR attacks. No association between PR episodes and prior consumption of certain foods could be documented in the other 11 patients.

In some PR patients ingestion of certain foods, specific for each case, can trigger the typical attack. It is suggested that this association should be looked for in any PR patient, as elimination of the offending food from the diet may help in preventing the PR attacks.