**Abstract**

Palindromic rheumatism is a syndrome characterized by recurrent, self-resolving, and inflammatory attacks in and around the joints that have long recognized association with rheumatoid arthritis. PR attacks mostly start in small joints i.e. knees, shoulder, and small joints of the hand. Whether PR should be considered as a single disease or prodrome of RA remains a thought-provoking question. Multiple genetic and environmental factors contribute to the development of PR. Many studies have explained the relationship between a high concentration of Anti-CCP antibodies and PR. Potential benefits of Gold therapy have been recognized in literature but still, there are some questions about toxicity and efficacy that need further considerations. In addition to that anti-malarial drugs, Abatacept, Tofacitinib, and Rituximab showed the variable result in different patients and needed further study to validate their medical use. Moreover, yarrow, oat, colchicum, dill, fennel, wild rue, bitter melon, willow, garlic, and burdock seem suitable candidates to treat rheumatoid although their use in PR is still not reported. Additional experimental researches on these drugs lead to an increase in our knowledge to fight against PR in the future using novel therapeutic approaches. We have attempted to cover this topic in a chapter form to provide a comprehensive view and hope that it will serve as a reference for clinicians who treat patients with PR.

**Keywords:** palindromic rheumatism, rheumatoid arthritis, environmental risk factors, genetic risk factors, therapies

#### **1. Introduction**

Palindromic rheumatism constitutes episodic and recurrent attack of articular inflammation that lasts from a few hours to several days which conclude without residual joint damage [1]. PR tends to affect small joints mostly, so the Knees, Shoulder, and small joints of hands are more prone to attack. Characteristic symptoms of PR include pain, swelling, redness, and disability of joints. This idiopathic condition was firstly described by Hench and Rosenberg in 1944 [2–6].

Distinctive features of PR include reoccurrence of attack at regular intervals and symptoms-free periods between attacks. Several studies have shown that about half of patients with PR develop Rheumatoid Arthritis (RA) and other joint diseases in later life [7]. PR is a single disease or spectrum of RE a leading question that is unanswered for 70 years. However, the target tissues are mostly the same in PR and RA [6, 8].

A high concentration of Rheumatoid factor and Anti -CCP antibodies in both PR and RA strengthen the correlation between the two diseases. However, despite these similarities, PR is different from RA in that joints are free of symptoms between attacks. According to research attacks of PR usually affect one joint but other structures can be affected in 30% cases and Rheumatoid nodules also appear in one-third cases of PR. Time of attack is not definite however according to Research in London 50% of patients develop attack of PR in the late afternoon and some others at night time [7–9].
