Palindromic onset of rheumatoid arthritis. Clinical, synovial fluid, and biopsy studies

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Abstract
Five patients had episodic arthritis consistent with palindromic rheumatism that evolved into definite or classic rheumatoid arthritis after 1 or more years. Synovial effusions during palindromic episodes had various leukocyte counts; mononuclear cells predominated in 4 patients. Neither these effusions nor needle synovial biopsies that showed subacute superficial inflammation and microvascular disease allowed any prediction that the disease would evolve into rheumatoid arthritis. Electron‐dense deposits in vessel walls suggested circulating immune complexes. There was also prominent, unidentified debris in vessel walls and in phagocytic vacuoles, which might also be important in pathogenesis.