PALINDROMNY RHEUMATISM (grech, palindromos moving back, returned; rheumatism; synonym syndrome of Hencha — Rosenberg) — extremely rare form of an acute inflammation of joints and circumarticular fabrics proceeding in the form of sudden short and completely reversible attacks. The item of river is for the first time described in 1944 F. Henchem and E. F. Rosenberg.
The etiology and a pathogeny
the Aetiology and a pathogeny are not found out. The assumption of the infectious and allergic nature of a disease does not find accurate clinical laboratory confirmations. Also P.'s relation of river to a pseudorheumatism is not proved though it is known that nek-ry sick P. have a river eventually, sometimes in many years, the typical picture of a pseudorheumatism comes to light.
At the research of synovial exudate, bioptat of a synovial membrane and hypodermic small knots (which are found seldom) find signs of a nonspecific inflammation with dominance among cellular elements of neutrophilic leukocytes. After the attack full involution of changes is noted.
The clinical picture
the Clinical picture is characterized by periodic emergence of the attacks. The beginning its usually instant, in the second half of day. One some joint, a thicket humeral, radiocarpal, small joints of brushes, knee, talocrural, temporal and mandibular, cervical department of a backbone is surprised. Within several minutes the joint painfully swells up a little, the maximum of changes is found in several hours. Pain is preferential moderate, but happens also the cutting which is tearing apart, demanding in exceptional cases purpose of drugs. Skin over a joint of weak-pink or dark red color. Extraarticular defeats are found in V3 of patients: in circumarticular fabrics there are sites of a painful dense swelling without itch and burning sometimes reminding a Quincke's disease. In hard cases it is possible to observe emergence of quickly disappearing hypodermic small knots, to-rye a thicket are localized in phalanxes of fingers of hands and over a palmar aponeurosis. The general condition of the patient does not suffer, temperature does not increase, function of a joint is temporarily broken only at severe pains. In blood only the number of lymphocytes sometimes is raised. ROE is slightly accelerated at heavy attacks. The rhematoid factor in blood serum is not defined. At a X-ray analysis of joints pathology does not come to light. Each attack of P. of river lasts from several hours to 1 — 2 days, seldom week and terminates in remission. Intervals between the attacks irregular. At the repeated attacks of a tendency to damage of the same joints is not present.
the Diagnosis is based on features of a clinical course of the joint attacks, existence of defeat of circumarticular fabrics.
Differential diagnosis carry out first of all with pseudorheumatism (see), at Krom joint process tends to recur in earlier affected joints, the long time remains, the lab is followed by the general symptoms (weight loss, the general weakness) and changes. indicators (anemia, acceleration of ROE and so forth).
At intermittent hydrarthrosis (see) unlike P. rubles are surprised in each case and at each attack same, preferential knee, joints; attacks of a maloboleznenna, and intervals between them regular. The item of river differs from gouts (see) lack of a hyperuricemia, from rheumatism (see) — absence of fever, signs of a carditis and changes a lab. indicators.
Various medicines it is difficult to estimate efficiency of treatment of a bad attack because of short duration of the attacks and their spontaneous termination.
Forecast, as a rule, favorable.
Bibliography: The reference book on rheumatology, under the editorship of V. A. Nasonova, page 149, M., 1978; Ehrlich G. E. Intermettent and periodic arthritic syndrome, in book: Arthritis and allied conditions, ed. by D. J. McCarty, p. 665, Philadelphia, 1979; H e n with h P. S. a. Rosenberg E. F. Palindromic rheumatism, Arch, intern. Med., y. 73, p. 293, 1944, bibliogr.
AA. P. Agababova.