To investigate the relationship between prior joint involvement during flares of palindromic rheumatism and the development of persistent inflammatory arthritis.
Approach:
Key Findings:
Prior joint involvement during flares was associated with approximately two times the odds of progression to persistent inflammatory arthritis in the same joint.
Hands and shoulders were the most frequently involved sites during initial flares, with small joints of the hands predominating.
At progression, 19% of joints with synovitis had been involved at the initial flare, while 60% were involved during subsequent flares.
Patients with a palindromic rheumatism prodrome had higher swollen joint counts but lower disability scores compared to those who progressed without it.
Interpretation:
The findings suggest that clinicians should monitor previously affected joints in patients with palindromic rheumatism, as local tissue factors may influence the transition to persistent arthritis.
Limitations:
Potential recall bias for initial flares.
Incomplete joint-level data.
Limited power for subgroup analyses.
Conclusion:
The strong association between prior flares and subsequent persistent arthritis highlights the importance of local joint factors, suggesting a need for targeted therapies.
