Treatment of palindromic rheumatism: A systematic review

Palindromic rheumatism (PR) characterised by self-resolving attacks of arthritis and peri-arthritis that may progress to other autoimmune connective tissue diseases (CTDs). The aim of this systematic review was to analyse the effectiveness of different treatments on PR.

Articles were collected from Cochrane, PubMed, Science Direct, Scopus, ProQuest, Ebsco, Google Scholar, MEDLINE and EMBASE. Search keywords were "palindromic rheumatism," "palindromic rheumatism and remission," "palindromic rheumatism and course," "palindromic rheumatism and prognosis," "palindromic rheumatism and treatment" and "palindromic rheumatism and therapy." The studies that were included met the following criteria: (a) adult patients aged ≥16 with PR; (b) being on treatment with medications defined as those that were developed for the treatment of inflammatory arthritis and (c) including outcome measures to evaluate the efficacy of the treatment including remission rate and progression to other diseases.

Twenty-four studies met the inclusion criteria. Although case series and retrospective studies showed that conventional disease-modifying antirheumatic drugs (DMARDs) can control attacks of the disease, 15%-70% of patients with PR evolve to autoimmune CTDs during several years, despite treatment with DMARDs. A retrospective study showed that tight control strategy could control attacks of the disease and prevent its progression to RA. The evidence provided from available studies is insufficient to determine that DMARDs can prevent the progression of PR to autoimmune CTDs.

Although case series and retrospective studies showed that DMARDs can control attacks of the disease, our review suggests that randomised clinical trials and prospective studies with adequate sample size are needed to prove that DMARDs can prevent progression of PR to autoimmune CTDs and which DMARDs are preferred for the treatment of PR.