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How to keep a flare diary for palindromic rheumatism

Palindromic attacks are usually over before anyone else gets to see them. A diary is how an attack that ended on Tuesday still counts at an appointment three weeks later.

By Peter Barnett, who makes Aura · Updated 25 October 2026 · Not medical advice

Why it matters more with this condition

Every proposed set of diagnostic criteria for palindromic rheumatism asks for an attack observed by a doctor, and for several different joints involved across attacks.¹ Attacks usually last under three days, and the joints are normal in between,¹ so the doctor often sees nothing at all. People with the condition describe long waits for a diagnosis, and say the symptoms seemed mild by the time they were seen.² A dated record, ideally with photographs, is the best substitute for being seen mid-attack.

Once there is a diagnosis, the same record answers the questions that shape treatment: are attacks getting more or less frequent, are they lasting longer, is the medication doing anything?

What to record during an attack

• Date and time it started, as near as you can tell. Write the time it ended once it does.
• Which joints, and which side. "Right index knuckle and right wrist" is more useful than "hand".
• Pain from 0 to 10 at its worst. Use the same scale every time so attacks can be compared.
• What you can see: swelling, redness, warmth, or none of those.
• Medication: what you took, when, and whether it seemed to make a difference.
• Anything unusual in the day or two before: poor sleep, illness, unusual exertion, stress, a big meal, alcohol. Record it without deciding it was the cause.

Take photographs

Swelling and redness are exactly the evidence that disappears before an appointment. Photograph the affected joint next to the same joint on the other side, in good light, and again once it settles. Phone photos carry the date automatically. Bring them to the appointment, and make sure they are easy to find.

Count the good days too

This is the part most diaries leave out. Suppose you notice three attacks after a bad night's sleep. That only means something if bad nights are rare. If you have a bad night twice a week, three attacks after one is what you would expect by chance.

The fix is cheap: mark every day on a calendar, with a tick for a normal day and an F for an attack, plus a note against anything you suspect. After a few months you can compare how often attacks follow a suspected trigger with how often they follow ordinary days. Be wary of conclusions drawn from a handful of attacks: with five flares, one more changes every percentage dramatically.

Common mistakes

• Filling it in from memory a week later. Durations shrink and pain scores drift.
• Only logging the bad ones. Small attacks are still attacks, and they still count toward frequency.
• Changing the pain scale partway through. A 6 should mean the same thing in March as in June.
• Bringing a stack of notes without a summary. Lead with attack count, typical duration and the joints involved.

This page is general information about record keeping. It is not medical advice. If an attack is unlike your usual ones, or a joint is hot, very swollen and you feel unwell, seek medical help promptly.