At that initial onset, it involved only her palindromic rheumatism right shoulder and the structures immediately around it. The pain quickly evolved, and within a few hours it had reached its maximum intensity. Interestingly, the patient had palindromic rheumatism no preceding morning stiffness or other constitutional symptoms. Movement exacerbated the pain.
Palindromic rheumatism she tried Tylenol and immobilization of her right arm, but these did not help. Her primary care physician recommended ibuprofen, which also provided no relief. Then, just as quickly as the pain came on, palindromic rheumatism it spontaneously resolved. Our patient suffered no subsequent complications or consequences.
However, a month later, the pain returned in a very similar fashion. It came on very quickly and again only involved one joint. It evolved over the course of a few hours and was palindromic rheumatism excruciatingly intense. This time, though, instead of affecting her right shoulder, it was her left wrist. After 24 hours, the pain again mysteriously abated. Over the course palindromic rheumatism of the next year, our patient had these attacks about once a month.
They affected her fingers, wrists, elbows, shoulders, hips, knees, and even her jaw at one point, with each episode only attacking one joint. Throughout this, she had no constitutional symptoms such as fevers, fatigue, or unintentional weight loss. Between each of these episodes, she was completely asymptomatic, and her activities of daily living were never compromised.
Our patient had no history of Lyme disease or sexually transmitted diseases. Laboratory studies drawn by her primary care physician were unremarkable:palindromic rheumatism her sedimentation rate was 3M/hr; C-reactive protein was 0.9 mg/dl; rheumatoid factor was negative on two occasions; ANA was negative; Lyme serologist were negative, and all cultures, including those for gonorrhea and Chlamydia, were negative. The patient had no significant past medical history, and her social history palindromic rheumatism and family history were non-contributory. Despite her episodic arthritis, she never missed a day of work and was still able to enjoy her hobbies. She did not take any prescription or over-the-counter medications.
