The recording you
hear was not created by The IPRS.
The opinions expressed within are
not necessarily the same as those of the IPRS. The recording is played purely
for the interest of anyone browsing this website.
"PR" also known as Hench-Rosenberg
syndrome or Hench’s syndrome.
"PR" gets it's name from a Palindrome,
usually associated with a word like Hannah spelt the same forward and back i.e.
comes and goes, but with Rheumatism it basically means comes and goes.
Although in my case having had it for many
years the pain just doesn't go away any more.
The "comes and goes" also applies to it
moving from one joint to another affected joint, sometimes in many joints at
once. It also applies to damage caused to joints unlike Rheumatoid Arthritis
after a "flare up" (inflammation of the joint and surrounding tissue) the joint
usually returns back to normal without any permanent joint damage.
However PR is different to RA (Rheumatoid
Arthritis) and Arthritis, as PR doesn’t cause any significant bone damage and PR
can also affect the soft tissue away from the joints. Some people get diagnosed
as "PRA" in the case of Palindromic Rheumatoid Arthritis and "PA" Palindromic
Arthritis. This could be because you have arthritic (or RA) symptoms that come
and go, rather than having typical PR symptoms. You may have also been diagnosed
as PRA when you have PR because you also have a positive 'RF' (Rheumatoid
Factor). There is a lot of overlap between them.
There aren't any specific numbers on the
amount of people in the UK or around the World affected with PR. As some have
gone on to develop "RA" (Rheumatoid Arthritis) or another Autoimmune Disorder by
the time a diagnosis is made, also with people not being diagnosed or being
given a wrong diagnosis. The IPRS is trying to reach all those affected by PR so
we do have an idea of the numbers.
Below is a summary of found information
about PR that has been compiled together for the ease of having it all in one
place. They are the medical worlds definitions and therefore not necessarily the
views of the IPRS.
Also known as:
Philip Showalter Hench
Edward Frank Rosenberg
The unusual features of this syndrome consists of the sudden and rapidly
developing afebrile attacks of arthritis or periarthritis, occasionally
paraarthritis, that continue for a few hours or a few days and then disappear
completely. There is pain, redness, swelling, and disability of one (usually) or
multiple joints. The interval between recurrent attacks is extremely variable.
There are no joint deformities or roentgenographic manifestations.
Hench and Rosenberg suggested the term «palidromic rheumatism», meaning
«repeated course». It was entered in the international rheuma nomenclature in
P. S. Hench, E. F. Rosenberg:
Palidromic rheumatism. A «new», often recurring disease of joints (arthritis,
periarthritis, para-arthritis) apparently producing no articular residues -
report of thirty-four cases; its relation to «angioneural arthrosis,» «allergic
rheumatism,» and rheumatoid arthritis.
Archives of Internal Medicine, Chicago, 1944, 73: 293-321.
WHAT IS PALINDROMIC
Rheumatism, also known as Hench-Rosenberg syndrome or Hench’s syndrome, was
named for Nobel Prize winner Philip S. Hench and his partner Edward Frank
Rosenberg. Mr. Hench (1896-1965) received his doctorate in medicine from the
University of Pittsburgh in 1920. His association with the Mayo Clinic began in
1923 when he became first an assistant, then, three years later, Head of its
Department of Rheumatic Diseases. At the Mayo Clinic he specialized in arthritic
disease. In the course of his work he observed the favourable effects of
jaundice on arthritic patients, causing a remission of pain. Other bodily
changes, for example pregnancy, produced the same effect. These and other
observations led him gradually to the conclusion that the pain-alleviating
substance was a steroid. In the period 1930-1938, Dr. E. C. Kendall had isolated
several steroids from the adrenal gland cortex. After several years of
collaboration with Dr. Kendall, it was decided to try the effect of one of these
substances, Compound E (later named cortisone), on arthritic patients. In
1948-1949, cortisone was successfully tested on arthritic patients. Hench also
treated patients with ACTH, a hormone produced by the pituitary gland which
stimulates the adrenal gland.
Rheumatism is a form of an autoimmune disorder. Although PR is listed on the
World Rare Disease Listing, it is only one of about five-hundred types of
autoimmune disorders. Approximately 50 million Americans, 20 percent of the
population or one in five people, suffer from autoimmune diseases. An Autoimmune
disorder is a condition caused by an immune response against the body's own
tissues. The immune system protects the body from potentially harmful substances
(antigens) such as micro organisms, toxins, cancer cells, and foreign blood or
tissues from another person or species. Antigens are destroyed by the immune
response, which includes production of antibodies (molecules that attach to the
antigen and make it more susceptible to destruction) and sensitized lymphocytes
(specialized white blood cells that recognize and destroy particular antigens).
Immune system disorders occur when the immune response is inappropriate,
excessive, or lacking. Autoimmune disorders develop when the immune system
destroys normal body tissues. This is caused by a hypersensitivity reaction
similar to allergies, where the immune system reacts to a substance that it
normally would ignore. In allergies, the immune system reacts to an external
substance that would normally be harmless. With autoimmune disorders, the immune
system reacts to normal "self" body tissues.
Normally, the immune system is capable of differentiating "self" from "non-self"
tissue. Some immune system cells (lymphocytes) become sensitized against "self"
tissue cells, but these faulty lymphocytes are usually controlled (suppressed)
by other lymphocytes. Autoimmune disorders occur when the normal control process
is disrupted. They may also occur if normal body tissue is altered so that it is
no longer recognized as "self." The mechanisms that cause disrupted control or
tissue changes are not known. One theory holds that various micro organisms and
drugs may trigger some of these changes, particularly in people with a genetic
predisposition to an autoimmune disorder.
Palindromic Rheumatism derives its name from the term "palindrome" — a word that
is spelled the same forward as backward (examples include "kayak" and "mom") —
emphasizing how the illness begins and ends in a similar way. It is a rare type
of inflammatory arthritis that causes sudden inflammation in one or several
joints, lasts a few hours or up to a few days, and then goes away completely.
The problem usually involves 2 or 3 joints, which have onset over hours and last
days - weeks, before subsiding. However episodes of recurrence form a pattern,
with symptom free periods between attacks lasting for weeks to months. The large
joints are most commonly involved. The soft tissues are also involved with the
swelling of the periarticular tissues, especially heel pads and the finger pads.
Although the backs of hands, the top
of feet and the lower fore arm are also common areas that are affected by
swelling of the soft tissue.
Nodules may be found in the subcutaneous tissues.
Constitutionally, the patient may or may not have a fever, and swelling of the
Palindromic rheumatism is a disease of unknown cause. It has been suggested that
it is an abortive form of rheumatoid arthritis, since anti-cyclic citrullinated
peptide antibodies (anti-CCP) and antikeratin antibodies (AKA) are present in a
high proportion of patients, as is the case in rheumatoid arthritis. Unlike RA
and some other forms of arthritis, palindromic rheumatism affects men and women
equally. It typically affects people between the ages of 20 and 50. No single
test can confirm a diagnosis. A doctor may make a diagnosis based on medical
history and signs and symptoms. Palindromic rheumatism must be distinguished
from acute gouty arthritis and an atypical, acute onset of rheumatoid arthritis.
Without specific tests (such as analysis of joint fluid), it may be difficult to
distinguish palindromic rheumatism from other episodic joint problems. It is
important to note that a person may experience more than one autoimmune disorder
at the same time. Laboratory findings are usually normal. Blood tests may show
an elevation of the ESR and CRP, but are otherwise unremarkable. Rheumatoid
factor may be present especially in the group that is likely to develop
The Podcast (recording) is one I found on the internet, talking about PR. It is interesting to listen
to and It was recorded in 2005.
The IPRS clearly would like to
thank Dr M ike
Mc M ahon
for creating this audio blog and for letting us use it.
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