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Can you have both palindromic arthritis and rheumatoid arthritis?

Q) I was very interested in the article about palindromic rheumatism and felt that after 25 years of pain, disability and frustration I was finally reading something which explained my symptoms.

I had two years of flare-ups in my joints before getting a positive rheumatoid arthritis blood test. Over the years I've had longer term swelling in joints which have led to damage. However, the pain and pattern is totally different to the original flare-ups.

Over the years I've continued to suffer the flare-ups regularly while blood tests show the rheumatoid arthritis to be largely under control with methotrexate. I spoke to my nurse about a diagnosis of palindromic rheumatism, but she told me that you can't have both.

I understand that the treatments are the same, but I've become frustrated with the rheumatologist describing these flare-ups as if they're nothing more than moans about normal everyday pains suffered by the general population. Can you have both? Does palindromic rheumatism continue alongside rheumatoid arthritis or morph into it?
Susan, via email (Summer 2015)

A) Really interesting question, thank you. Palindromic rheumatism is a challenging condition to live with and to diagnose. But from what you describe in your email it does sound as though you currently have rheumatoid arthritis with flare-ups, rather than palindromic rheumatism.

It's true that a small proportion of people with palindromic rheumatism go on to develop rheumatoid arthritis and it may be that this is what you had originally, as more people with palindromic rheumatism who have positive rheumatoid factor blood tests go on to develop rheumatoid arthritis.

But it may also be true that you have had rheumatoid arthritis all along but that it took longer for your rheumatoid factor blood tests to come up positive. Current thinking is that palindromic rheumatism can morph into rheumatoid arthritis, but it doesn't seem to continue alongside it. That said, it's true to say there's a lot we don't know about palindromic rheumatism, so it's not beyond the realms of possibility that the two conditions can coexist.

One of the big differences between the two conditions is that you don't usually see joint damage in palindromic rheumatism

The second point you raise seems to be more about the relationship with you rheumatology team. It's unfortunate that you feel your flare-ups are being treated as nothing more than everyday moans. It sounds like perhaps your rheumatoid arthritis isn't being well enough controlled by the treatment you're taking currently, so it's worth further discussion with your rheumatology team.

If you feel you are being dismissed unsatisfactorily then you're within your rights to ask for a second opinion from another rheumatologist.

This answer was provided by Dr Tom Margham for the Summer 2015 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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