A review of 39 patients diagnosed as suffering from palindromic rheumatism showed that 17 cases had evolved into typical rheumatoid arthritis (RA), while 22 had remained palindromic. The pattern of palindromic attacks in the two groups gave no grounds for regarding palindromic rheumatism as a separate condition from RA with palindromic onset. At the first attendance minor clinical or radiological changes, raised erythrocyte sedimentation rate, and positive serology were more common along those patients who were about to develop the picture of RA. Rheumatoid disease developing in patients with a palindromic onset was at least as severe as that among other patients with RA. 5 patients gave a history suggestive of fluid retention during the palindromic episodes, suggesting that attacks might be related to circulating immune complexes and altered vascular permeability. However, samples of blood obtained from 6 patients both during and between attacks showed no reduction in any of a variety of complement components tested.
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