Abstract Background/Aims Palindromic rheumatism is a rare, episodic arthritis marked by sudden joint pain and swelling that resolves fully between attacks. Its variable course, overlap with other diseases, and lack of validated criteria cause diagnostic challenges. This study evaluates and compares existing diagnostic frameworks for PR in a defined patient cohort. Methods A cross-sectional observational study was conducted at Dr Shenoy’s CARE Clinic, Kochi, over a one-year period (2023-2024). The study enrolled 402 participants, including 302 patients diagnosed clinically with PR and 100 control patients with other diseases who had intermittent joint symptoms. Baseline demographic data, clinical features, and serological markers such as rheumatoid factor (RF), anti-CCP antibodies, and ANA were recorded. Radiographic findings were also noted where applicable. Diagnostic performance of each criterion set was assessed using sensitivity, specificity, positive predictive value, negative predictive value, and ROC curve analysis. Cohen’s kappa statistics were used to assess agreement between criteria. Results Among 402 participants, PR cases were predominantly female (70.5%) with a mean age of 46.8 years, and 64.6% were RF or anti-CCP positive, challenging its traditional seronegative label. González-López criteria had perfect sensitivity (100%) but very poor specificity (14%). Pasero and Barbieri criteria showed high specificity (85%) but very low sensitivity (13.9%). Hannonen criteria had moderate sensitivity (48.3%) and low specificity (36%), while Guerne and Weisman criteria showed similar sensitivity (45.7%) with slightly higher specificity (50%). ROC analysis showed poor diagnostic performance for all frameworks (AUC 0.43-0.57), indicating no existing criteria balance sensitivity and specificity effectively. Conclusion Current diagnostic criteria for PR lack the optimal balance of sensitivity and specificity. The González-López criteria were highly sensitive but poorly specific, whereas the Pasero and Barbieri criteria missed most cases. Findings support PR as frequently seropositive rather than merely a precursor to RA. There is an urgent need for validated, consensus-based criteria incorporating clinical and serological features. Disclosure H. Hari: None. R. Umesh: None. P. Shenoy: None.
Hari et al. (2026) studied this question.