Remitting seronegative symmetrical synovitis with pitting edema is a rare rheumatological disorder that presents with symmetrical hand andor foot edema resembling rheumatoid arthritis. Remitting seronegative symmetrical synovitis with pitting edema is a rare syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema of. In the latter, the clinical picture of rs3pe developed after surgical intervention for the primary lesion. Patients have been found to respond well to low dose corticosteroids and to remain in remission paira et al. This is the first case to be reported of remitting seronegative symmetrical synovitis with pitting edema syndrome rs3pe under nivolumab. Remitting seronegative symmetrical synovitis with pitting edema rs 3 pe syndrome is a distinct disease entity that was first described by mccarty et al. An abrupt onset of pitting edema of the dorsum of the hands associated with synovitis of the wrist carpus, small joints, and tendon sheaths are described clinical features. Remitting inflammatory arthritis of hands and feet affecting primarily the elderly. If no underlying disorder can be identified idiopathic rs3pe, this entity has an excellent prognosis and responds well to treatment. The pitting edema and inflammatory response quickly subsided after lowdose prednisolone therapy. Most cases of remitting seronegative symmetrical synovitis with pitting edema syndrome are idio pathic, but some are secondary to malignancy, autoimmune disease, or neurodegenerative disorders.
Patients show excellent response to low dose steroids with complete and sustained remissions. The objective of this study was to clarify the characterizations of polymyalgia rheumatica pmr and remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome. Rs3pe remitting seronegative symmetrical synovitis with pitting edema. Pdf remitting seronegative symmetrical synovitis with. Sjogrens syndrome presenting as remitting seronegative. A 75yearold male who was undergoing chronic hemodialysis developed abruptonset pitting edema and pain in the dorsum of both hands and feet.
Though the nature of the disease still remains illusive, the outcome is excellent. Comparison between polymyalgia rheumatica and remitting. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare but wellreported clinical entity. We report 2 elderly patients who present with a relatively acute onset of a severe symmetrical synovitis affecting the flexor digitorum tendon sheaths and wrist joints with pitting edema of the dorsum of both hands.
Eight elderly men and two elderly women presented with symmetrical polysynovitis of acute onset involving most of their appendicular joints and flexor digitorum tendons associated with pitting edema of the dorsum of both hands and both feet. To compare clinical features of patients with remitting seronegative symmetrical synovitis with pitting edema rs3pe and patients with polymyalgia rheumatica pmr and to explore the purported association between rs3pe and malignancy. Remitting seronegative symmetrical synovitis with pitting edema is a rare syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema swelling. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome was first reported by mccarty et al. To contrast and compare the spectrum of remitting seronegative symmetrical synovitis with pitting edema rs3pe with rheumatoid arthritis ra using an illustrative case.
However, few cases occurring with lung cancer have been reported. Remitting seronegative symmetrical synovitis with pitting. P142 paraneoplastic remitting seronegative symmetrical synovitis with pitting edema rs3pe. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare condition in the elderly and can appear as a first presentation of various types of rheumatic and malignant diseases. Steroidresistant remitting seronegative symmetrical. To investigate whether the remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome may represent a paraneoplastic disorder in a significant percentage of cases. Computed tomography and gallium scintigraphy revealed no active infection or neoplasms. We hereby report a case of unilateral rs3pe in a patient of seronegative rheumatoid arthritis which was. Is remitting seronegative symmetrical synovitis with pitting. Sep 26, 2016 remitting seronegative symmetrical synovitis with pitting edema syndrome has been reported to be associated with malignant tumors. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare syndrome consisting of acute symmetrical tenosynovitis of the hands and wrists associated with pain and marked pitting. Paraneoplastic remitting seronegative symmetrical synovitis. Bucaloiu id, olenginski tp, harrington tm, remitting seronegative symmetrical synovitis with pitting edema syndrome in a rural tertiary care practice.
Remitting seronegative symmetrical synovitis with pitting edema abbreviated rs3pe or sometimes rs 3 pe is a rare syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema of the back of the hands andor feet, and a negative serum rheumatoid factor. We report a patient with remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome and elevation of matrix metalloproteinase 3 mmp3. Patients diagnosed with rs3pe syndrome at the medical college of wisconsin before 1995 were telephoned and asked about their rheumatologic course since initial diagnosis of rs3pe. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a specific type of arthritis, especially affecting the elderly 1, 2. It is classically described as symmetrical involvement of both upper extremities.
Oct 31, 2003 we report two cases of paraneoplastic remitting seronegative symmetrical synovitis with pitting edema rs3pe associated with prostatic adenocarcinoma. Rs3pe remitting seronegative symmetrical synovitis with. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is an unusual inflammatory arthritis with unknown pathogenic mechanism, and is characterized by an acute onset of symmetrical synovitis with pitting edema of the hands or feet. Is remitting seronegative symmetrical synovitis with. Onset of seven of the ten cases could be pinpointed almost to the hour. Objectiveto evaluate the outcome of patients with remitting seronegative symmetrical synovitis with pitting oedema rs3pe.
Remitting seronegative symmetrical synovitis with pitting oedema. Remitting seronegative symmetrical synovitis with pitting oedema syndrome, a rare inflammatory arthritis, commonly affects people in the older age group. Unilateral rs3pe in a patient of seronegative rheumatoid. Evaluation of seronegative arthritis differential diagnosis. How is remitting seronegative symmetrical synovitis with pitting edema abbreviated. Whether the rs 3 pe is a unique disease or syndrome has long been discussed, the real nature of the syndrome is still a matter of debate. Rs3pe is a type of benign seronegative polyarthritis that affects older people and is characterised by sudden onset of oedema and swelling of the dorsum of the hands with. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome is a definite subset of the seronegative symmetrical polyarthritis of the aged, characterized by dramatic pitting edema of the hands, male predominance, old age and exquisite response to. Remitting symmetrical seronegative synovitis and pitting edema. The anatomical determinant of rs3pe is predominantly extensor tenosynovitis as revealed by magnetic resonance imaging mri. S ir, remitting seronegative symmetrical synovitis with pitting oedema rs3pe is a rare disorder characterized by acuteonset seronegative remitting polyarthritis with distal pitting oedema. Aug 29, 2008 remitting seronegative symmetrical synovitis with pitting oedema syndrome, a rare inflammatory arthritis, commonly affects people in the older age group. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome daniel j. Idiopathic remitting seronegative symmetrical synovitis.
Biochemical analysis disclosed increased creactive protein, and negative rheumatoid factor and antinuclear antibody. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is associated with different rheumatologic and neoplastic diseases, typically in elderly men. A detailed history and a thorough physical exam should enable the diagnosis to be elucidated in most patients. It is remitting seronegative symmetrical synovitis with pitting edema. Remitting seronegative symmetrical synovitis with pitting edema syndrome has been reported to be associated with malignant tumors. Explore more on remitting seronegative symmetrical synovitis with pitting edema below. Dec 06, 2015 remitting seronegative symmetrical synovitis with pitting edema is a rare syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema of the back of the hands andor feet, and a. We presented a 62yearold man with the diagnosis of rs3pe based on the clinical sign and laboratory data. A 77yearold man presented with poly arthritis both shoulders, knees. Neki, ankur jain, rohit bajaj, mohit manav jindal department of medicine, government medical college and guru nanak dev hospital, amritsar, india remitting seronegative symmetrical synovitis with pitting oedema rs 3pe is a rare clinical entity.
Remitting seronegative symmetrical synovitis with pitting edema rs3pe. Remitting seronegative symmetrical synovitis with pitting edema syndrome in a chronic hemodialysis patient article pdf available in case reports in medicine 201219. This syndrome, which has a sudden onset and characterized by edema with swelling on the dorsum of the hands, synovitis on the elbows and. Syndrome of remitting seronegative symmetrical synovitis.
Remitting seronegative symmetrical synovitis pitting edema. Synovitis with pitting edema rs3pe syndrome which is characterized by. Explore more on remitting seronegative symmetrical synovitis. Case report an 80yearold man presented in 2001 with a superficial spreading melanoma on the left forearm, breslow 1. Remitting, seronegative, symmetric synovitis with pitting edema rs3pe is a syndrome with an acute onset, benign course characterized by rheumatoid factor.
Remitting seronegative symmetrical synovitis with pitting edema rs3pesyndrome. Rs3pe stands for remitting seronegative symmetrical synovitis with pitting edema. Syndrome of remitting seronegative symmetrical synovitis with. Magnetic resonance imaging mri was used to describe the anatomical structures affected by inflammation in pure rs3pe syndrome. Mmp3 was more indicative of rs3pe syndrome symptoms than crp. Remitting seronegative symmetrical synovitis with pitting edema or sometimes rs 3 pe is a rare syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema swelling of the back of the hands andor feet, and a negative serum rheumatoid factor. Remitting seronegative symmetrical synovitis with pitting oedema rs3pe was first described by mccarty et al. Treatment of a patient with remitting seronegative, symmetrical synovitis with pitting oedema with a humanized antiinterleukin6 receptor antibody, tocilizumab toshio tanaka 1 department of respiratory medicine, allergy and rheumatic diseases, osaka university graduate school of medicine and 2 laboratory of immune regulation, osaka university.
The clinical spectrum of remitting seronegative symmetrical synovitis with. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare inflammatory condition characterized by symmetrical synovitis of the hands and feet with pitting edema. Remitting seronegative symmetrical synovitis with pitting oedema rs3pe syndrome is a very rare clinical entity including a tenosynovitis of the hands and wrists, and marked pitting oedema on upper and lower extremities. Jan 29, 2012 radiological examination showed no bony erosion. Remitting seronegative symmetrical synovitis with pitting edema is a diseasesyndrome characterized by an acute onset of polyarthritis with pitting edema, negative rheumatoid factor, absence of joint erosions on radiographs, synovitis suggested by usgmri, and an exquisite response to lowdose steroids, with a sustained longterm response. Abrupt onset of marked dorsal swelling of the hands or feet with pitting edema, wrist synovitis, and flexor finger tendinitis. Pleural and pericardial effusions are unusual complications in idiopathic remitting seronegative symmetrical synovitis with pitting edema syndrome. Myelodysplastic syndrome precedes the onset of remitting. The clinical diagnosis was remitting seronegative symmetrical synovitis with pitting edema rs 3 pe syndrome. A 77yearold man presented with poly arthritis both. Numerous diseases are associated with rs3pe, including neoplasia, infection, parkinsons disease, and other rheumatic diseases. We here report a case of remitting seronegative symmetrical synovitis with pitting edema syndrome complicated with lung cancer. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is characterized by symmetrical synovitis predominantly involving the hands with pitting edema of the dorsum of the hands schaeverbeke et al.
Laboratory diagnosis blood test results were as follows. Objectiveto determine the clinical characteristics of patients with pure remitting seronegative symmetrical synovitis with pitting oedema rs3pe syndrome, and to investigate its relation with polymyalgia rheumatica pmr. Remitting seronegative symmetrical synovitis with pitting oedema rs3pe syndrome is a very rare clinical entity including a tenosynovitis of the hands and wrists, and marked pitting edema on upper and lower extremities. Asymmetrical involvement had also been reported, but unilateral presentation is very rare.
Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare clinical entity that is easily missed due to lack of knowledge. Serum matrix metalloproteinase 3 in detecting remitting. Rs3pe is defined as remitting seronegative symmetrical synovitis with pitting edema somewhat frequently. Hunter eight elderly men and two elderly women presented with symmetrical polysynovitis of acute onset involving most of their appendicular joints and flexor digitorum tendons associated with pitting edema ofthe dorsum both hands and both feet. We report two cases of paraneoplastic remitting seronegative symmetrical synovitis with pitting edema rs3pe associated with prostatic adenocarcinoma. Remitting symmetrical seronegative synovitis and pitting edema syndrome with concomitant adenocarcinoma of the lung. Rs 3 pe syndrome is characterized by symmetrical and acute synovitis, marked pitting edema, the absence of rheumatoid arthritis, increased acute phase reactants, lack of bony erosions on radiography, and a. It can present as an acute onset polyarthritis with associated pitting oedema of the extremities. We report 2 elderly patients who present with a relatively acute onset of a severe symmetrical synovitis affecting the flexor digitorum tendon sheaths and wrist joints. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome is characterized by symmetrical synovitis and swelling of both the upper and lower extremities. Patients diagnosed with rs3pe syndrome at the medical college of wisconsin before 1995 were telephoned and asked about their rheumatologic course since initial diagnosis of rs3pe and whether. Large joint arthritis andor pitting oedema of the dorsum of feet coexisted in some patients. It usually affects males, is usually steroid responsive and may be paraneoplastic. Seronegative arthritis describes a group of conditions that present with inflammatory arthritis but without a positive rheumatoid factor, hence seronegative.
Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare form of inflammatory arthritis, most often affecting elderly individuals and. Rheumaknowledgy remitting seronegative symmetric synovitis. Idiopathic remitting seronegative symmetrical synovitis with. Read remitting seronegative symmetrical synovitis with pitting edema syndrome associated with nonhodgkins lymphoma. Remitting seronegative symmetrical synovitis with pitting edema rs3pe, first described in 1985 by mccarty et al, is a rare syndrome that is a subset of the seronegative symmetrical polyarthritis of older people. An 81yearold woman presented acutely with a 2day history of a severe. Treatment of a patient with remitting seronegative.
Older males, 50 years of age, are predominantly affected. The relevant english literature of rs3pe was searched using the keywords rs3pe alone and in combination with terms such as neoplasia and rheumatic disease. One of the patients was positive for helicobacter pylori and the other had secondary bone metastases. Remitting seronegative symmetrical synovitis with pitting edema bioinformatics tool laverne is a handy bioinformatics tool to help facilitate scientific exploration of related genes, diseases and pathways based on cocitations. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome and rheumatoid arthritis were considered. Rs 3 pe syndrome is characterized by symmetrical and acute synovitis, marked pitting edema, the absence of rheumatoid arthritis, increased acute phase reactants, lack of bony erosions on radiography, and a benign. Clinical characteristics of patients with remitting. Seven patients with pmr and 12 patients with rs3pe were compared in terms of the type of onset, the complication rate of carpal tunnel syndrome cts, the initial usage of doses of prednisolone. Remitting seronegative symmetrical synovitis with pitting edema.
666 941 581 673 1051 214 305 1142 805 774 1237 1510 974 690 1356 1107 1184 1658 21 170 268 748 841 1123 1139 1542 261 238 496 1267 264 1179 1016 202 1577 458 625 187 1083 1025 878 976 631