How do the clinical features of palindromic rheumatism differ from those of intermittent hydrarthrosis?
Palindromic rheumatism, similar to intermittent hydrarthrosis, affects both men and women, often begins in the third to fifth decade, frequently affects the knees, and is rarely associated with constitutional symptoms. However, unlike intermittent hydrarthrosis, palindromic rheumatism attacks occur irregularly and may involve more than one joint (usually two to five joints). Arthritic attacks may last hours to several days. The pattern of attacks tends to be characteristic in an individual patient. Symptoms may begin in one joint while waning in another. Attacks are sudden and pain may be intense, often reaching a peak within a few hours. Signs of joint inflammation (swelling, warmth, redness) can be noted soon after pain begins. Small joints of the hands, wrist, and feet may be affected, and occasionally the temporomandibular joints. Also, unlike intermittent hydrarthrosis, periarticular attacks (occurring in one-third of cases) and transient subcutaneous nodules may be seen.