Overview
Recurrent rheumatism is also known as exacerbation rheumatism, Hench-Rosenberg syndrome, Hench syndrome, and palindromic rheumatism.It was first described as palindromic rheumatism (PR) by Hench and Rosenberg in 1944. It is characterized by recurrent episodes of acute arthritis and periarticular inflammation with no symptoms between episodes. The disease is most common in people aged 30 to 60 years, but can occasionally develop in childhood. It can occur in more than one person in the same family. Men and women have an equal chance of developing the disease.
Questions you may have
What is recurrent rheumatism?
Relapsing rheumatic disease is a rheumatic immune disease characterized by recurrent episodes of acute arthritis and periarthritis, with symptoms manifesting as joint involvement, and is treated clinically with medication.
Recurrent rheumatism, also known as exacerbation rheumatism, is most common in people between the ages of 30 and 60, and in a few cases it can also develop in childhood. The specific cause of this disease is still unclear. Clinical symptoms are mainly joint swelling, stiffness, pain and other joint involvement, and the onset is rapid and sudden, and the symptoms are more obvious in the evening. The skin on the extensor surfaces of the joints may also have bright red or dark red changes.
The treatment of this disease in the clinic is based on drugs, commonly used drugs include adrenocorticotropic hormone, penicillamine, colchicine and so on, please standardize the use of drugs under the guidance of the doctor, do not use drugs without authorization.
If recurrent rheumatism is identified, please seek medical treatment promptly to avoid aggravation of the disease.
Causes
Not much is known about the etiology of the disease, and it has been suggested that immune processes may be involved.
Symptoms
The disease often has a sudden onset, most often starting in the evening, with no prodromal symptoms. The joints of the limbs, knees, shoulders, wrists, elbows, ankles and palms and metatarsals are more likely to be involved, and may be single or multiple joints, usually asymmetrical. The joints are swollen, stiff, and painful, and joint pain is often very pronounced, peaking within a few hours, with the skin on the extensor surfaces of most (85%) joints appearing dark red or bright red. Recurrences are often confined to the joint where the previous attack occurred and may change joints. In addition to the joints, periarticular soft tissues may be involved, such as the finger pads, heels, and other soft tissues, which may become edematous and painful. Individuals have low-grade fever during the attack, usually no systemic symptoms, and occasionally subcutaneous nodules are found, but they disappear quickly and are not easy to detect. Symptoms usually resolve within 1 to 3 days, up to 1 week. There are no symptoms in the interval. There is no clear regularity of the attacks, more often than not, the attacks can be several times a week, and less often, the attacks are 1 to 2 times a year.
Examination
1. Laboratory tests
Blood sedimentation and various indicators of acute-phase reactions may increase during the attack. Synovial and joint fluid examination reveals non-specific acute inflammatory reaction without crystallization. Synovial biopsy reveals significant microvascular damage. During the interictal period, the above indicators are within the normal range.
2. Other examinations
X-ray examination during the attack shows no abnormality except swelling of the affected joint tissues.
Diagnosis
The diagnosis depends mainly on the clinical manifestations. Typical acute arthritis and periarthritis are recurrent, with no symptoms between attacks and no specific changes on X-ray. If there is only a mild attack without redness or swelling, the disease cannot be diagnosed.
Differential diagnosis
The disease needs to be differentiated from rheumatoid arthritis.
Treatment
1. Western medical treatment
Since the attack time is very short and can be relieved within 1~7 days, it is difficult to judge the efficacy of the treatment. At present, the most commonly used drugs are as follows
(1) Adrenocorticotropic hormone can be used to treat patients with frequent and severe seizures with small doses of prednisone.
(2) Penicillamine can reduce the number of attacks and prevent the disease from developing into rheumatoid arthritis. Side effects include fever, headache, gastrointestinal symptoms, decreased white blood cell count, and renal impairment. It is contraindicated for people with renal lesions.
(3) Colchicine This drug has the effect of reducing leukocyte activity and phagocytosis and anti-inflammatory and analgesic effects. Intermittent use of the drug can prevent attacks, and some efficacy has been reported.
2. Chinese medicine treatment
It can be treated according to the theory of “wind paralysis”, and is effective in dispelling wind and cooling blood, and relieving pain with a combination of medicines to relieve tendons and activate collaterals.
Prognosis
In a few cases, the symptoms will subside on their own and will not recur; in most patients, the symptoms will recur, but there will be no persistent synovitis or joint damage; in some cases, the symptoms will develop into typical rheumatoid arthritis. These patients are often positive for rheumatoid factor during the relapsing phase, and those who are negative may become positive during the progressive phase. Typical rheumatoid nodules often persist during the relapsing phase before chronic synovitis develops. Once the relapsing rheumatism progresses to rheumatoid arthritis, the episodes become more frequent but less severe, with more joints involved and more pronounced morning stiffness. The progression from relapsing rheumatism to rheumatoid arthritis takes anywhere from 5 to 20 years. The disease does not usually progress to systemic lupus erythematosus or other connective tissue diseases.
Prevention
1. Remove infected lesions, pay attention to hygiene, and strengthen physical exercise.
2. Live a regular life, combine work and rest, be in a good mood, and avoid strong mental stimulation.
3. Early diagnosis and treatment.