TY - JOUR T1 - Rheumatoid Arthritis Initiating as Palindromic Rheumatism: A Distinct Clinical Phenotype? JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.190061 SP - jrheum.190061 AU - Raul Castellanos-Moreira AU - Sebastian C. Rodriguez-Garcia AU - Jose Alfredo Gómez-Puerta AU - Virginia Ruiz-Esquide AU - Oscar Camacho AU - Julio Ramírez AU - Andrea Cuervo AU - Rosa Morla AU - Juan D. Cañete AU - Isabel Haro AU - Raimon Sanmarti Y1 - 2019/08/01 UR - http://www.jrheum.org/content/early/2019/07/23/jrheum.190061.abstract N2 - Objective To analyse the prevalence of pre-existing palindromic rheumatism (PR) in patients with established rheumatoid arthritis (RA) and evaluate whether these patients have a distinctive clinical and serological phenotype. Methods Cross-sectional study in patients with established RA. Pre-existing PR was determined using a structured protocol and confirmed by retrospective review of medical records. Demographic, clinical, radiological, immunological and therapeutic features were compared in patients with and without PR. Results 158 patients with established RA (78% female) with a mean disease duration since RA onset of 5.1 ± 2.7 years were included. Pre-existing PR was recorded in 29 patients (18%). The median time from the onset of PR to progression to RA was 1.2 years. No between-group differences in demographic features, current disease activity radiographic erosive disease or disability were observed. Patients with PR had a higher prevalence of smoking (72% vs. 40%). Positive rheumatoid factor, anti-citrullinated peptide antibodies and anti-carbamylated protein antibodies were numerically higher in patients with PR. No differences in treatment were observed except for greater hydroxychloroquine use in patients with PR (38% vs. 6%). Palindromic flares persisted in a significant proportion of patients during the RA course, including patients in clinical remission or receiving biological DMARDs. Conclusion Eighteen percent of patients with RA had a history compatible with PR previous to RA onset. No specific clinical or serological phenotype was identified in these patients, although higher hydroxychloroquine use and smoking prevalence were identified. Palindromic flares may persist during the RA disease course despite treatment. ER -