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Research ArticleRheumatoid Arthritis

Rheumatoid Arthritis Initiating as Palindromic Rheumatism: A Distinct Clinical Phenotype?

Raul Castellanos-Moreira, Sebastian C. Rodriguez-Garcia, José A. Gómez-Puerta, Virginia Ruiz-Esquide, Oscar Camacho, Julio Ramírez, Andrea Cuervo, Rosa Morlà, Juan D. Cañete, Isabel Haro and Raimon Sanmarti
The Journal of Rheumatology May 2020, 47 (5) 652-657; DOI: https://doi.org/10.3899/jrheum.190061
Raul Castellanos-Moreira
From the Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona; Unit of Synthesis and Biomedical Applications of Peptides, Institute of Advanced Chemistry of Catalonia (IQAC-CSIC), Barcelona, Spain.
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Sebastian C. Rodriguez-Garcia
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José A. Gómez-Puerta
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Virginia Ruiz-Esquide
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Oscar Camacho
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Julio Ramírez
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Andrea Cuervo
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Rosa Morlà
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Juan D. Cañete
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Isabel Haro
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Raimon Sanmarti
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Abstract

Objective. To analyze the prevalence of preexisting palindromic rheumatism (PR) in patients with established rheumatoid arthritis (RA) and to evaluate whether these patients have a distinctive clinical and serological phenotype.

Methods. Cross-sectional study in patients with established RA. Preexisting 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. Included were 158 patients with established RA (78% female) with a mean disease duration since RA onset of 5.1 ± 2.7 years. Preexisting 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, anticitrullinated peptide antibodies, and anticarbamylated protein antibodies were numerically higher in patients with PR. No differences in treatment were observed except for greater hydroxychloroquine (HCQ) 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 disease-modifying antirheumatic drugs.

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 HCQ use and smoking prevalence were identified. Palindromic flares may persist during the RA disease course despite treatment.

Key Indexing Terms:
  • PALINDROMIC RHEUMATISM
  • RHEUMATOID ARTHRITIS
  • ANTICITRULLINATED PROTEIN ANTIBODIES
  • HYDROXYCHLOROQUINE
  • ANTICARBAMYLATED PROTEIN ANTIBODIES
  • SMOKING

Footnotes

  • This study was supported by a grant from the Hospital Clínic of Barcelona, Research, Innovation and Education Department (Raul Castellanos-Moreira, Premi Fi de residencia: Emili Letang 37933).

  • Accepted for publication July 8, 2019.
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The Journal of Rheumatology
Vol. 47, Issue 5
1 May 2020
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Rheumatoid Arthritis Initiating as Palindromic Rheumatism: A Distinct Clinical Phenotype?
Raul Castellanos-Moreira, Sebastian C. Rodriguez-Garcia, José A. Gómez-Puerta, Virginia Ruiz-Esquide, Oscar Camacho, Julio Ramírez, Andrea Cuervo, Rosa Morlà, Juan D. Cañete, Isabel Haro, Raimon Sanmarti
The Journal of Rheumatology May 2020, 47 (5) 652-657; DOI: 10.3899/jrheum.190061

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Rheumatoid Arthritis Initiating as Palindromic Rheumatism: A Distinct Clinical Phenotype?
Raul Castellanos-Moreira, Sebastian C. Rodriguez-Garcia, José A. Gómez-Puerta, Virginia Ruiz-Esquide, Oscar Camacho, Julio Ramírez, Andrea Cuervo, Rosa Morlà, Juan D. Cañete, Isabel Haro, Raimon Sanmarti
The Journal of Rheumatology May 2020, 47 (5) 652-657; DOI: 10.3899/jrheum.190061
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Keywords

PALINDROMIC RHEUMATISM
RHEUMATOID ARTHRITIS
ANTICITRULLINATED PROTEIN ANTIBODIES
HYDROXYCHLOROQUINE
ANTICARBAMYLATED PROTEIN ANTIBODIES
SMOKING

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Keywords

  • PALINDROMIC RHEUMATISM
  • rheumatoid arthritis
  • ANTICITRULLINATED PROTEIN ANTIBODIES
  • hydroxychloroquine
  • ANTICARBAMYLATED PROTEIN ANTIBODIES
  • smoking

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