We hereby report a case of unilateral rs3pe in a patient of seronegative rheumatoid arthritis which was. Remitting seronegative symmetrical synovitis with pitting edema rs3pe and the syndrome of inappropriate antidiuretic. It is distributed in accordance with the creative commons attribution non commercial cc bync 4. We believe that it is still useful to define rs3pe as a specific syndrome particularly regarding its excellent prognosis as compared with the other affections responsible for pitting oedema of the hands. Remitting seronegative symmetrical synovitis with pitting oedema rs3pe was first described by mccarty et al. Rs3pe is a definite syndrome, subset of polyarthritis with favourable outcome and has a good prognosis in the older patients. To the best of our knowledge, this is the first case of unilateral rs3pe in a patient of rheumatoid arthritis, while on drugs. This syndrome could be mistaken by other polyarthritis, which normally affects the elderly.
Cantini f, salvarani c, olivieri i, benozzi l, macchioni l, nicolli l, et al. On the contrary, in our case symptoms were well controlled with dmards, and patient developed rs3pe when she was on medication. 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. Looking for online definition of rs3pe or what rs3pe stands for. The aetiology of the disease is still not well known but we can classify it as a disease with characteristic clinical features. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare inflammatory arthritis characterized by. Remitting seronegative symmetrical synovitis with pitting oedema syndrome, a rare inflammatory arthritis, commonly affects people in the older age group. The differential diagnosis of rs3pe syndrome includes rheumatoid arthritis ra, complex regional pain syndrome, gout arthritis, systemic lupus erythematosus sle, systemic sclerosis, overlap syndrome, mixed connective tissue disease, polyarteritis nodosa, amyloidosis, pseudogout disease, and carpal and tarsal tunnel syndromes. A case of paraneoplastic remitting seronegative symmetrical. Remitting seronegative symmetrical synovitis with pitting oedema rs3pe of hands and feet in an 83yearold man. Rs3pe can be an initial manifestation of pmr or may occur in its course. Dear editor, a 48yearold female presented with pain and swelling in the bilateral proximal interphalangeal pip, metacarpophalangeal mcp and wrist joints for the past 20 days. Rs3pe can be associated with neoplasia and various rheumatic conditions. Remitting seronegative symmetrical synovitis with pitting oedema 73.
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. Aug 29, 2008 remitting seronegative symmetrical synovitis with pitting oedema syndrome, a rare inflammatory arthritis, commonly affects people in the older age group. Rs3pe syndrome the rs3pe syndrome refers to remitting seronegative symmetrical synovitis with pitting edema, also described as the puffy edematous hand syndrome or distal extremity swelling with pitting edema. Full text pdf contact the author contact the editor. Rs3pe syndrome has also been associated with malignancies, 10, 16 and, therefore, screening for potential malignancies is required at the initial diagnosis. Remitting seronegative symmetrical synovitis with pitting edema rs3pe has been described as a limited. Patients with idiopathic rs3pe showed an excellent response to low doses of corticosteroids compared to the poor response to rs3pe in association with neoplasia.
Remitting seronegative symmetrical synovitis with pitting oedema rs3pe syndrome is a very rare condition incorporating a tenosynovitis of the hands and wrists, as well as the feet, ankles and. Objectiveto evaluate the outcome of patients with remitting seronegative symmetrical synovitis with pitting oedema rs3pe. 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. Rs3pe syndrome is an inflammatory disease, which affects mainly elderly men and responds rapidly to steroids. Pdf syndrome of remitting seronegative symmetrical. Rs3pe developed three years after leaving the drugs. Onset of seven of the ten cases could be pinpointed almost.
Apr, 2018 remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome was first reported in 1985 by mccarty et al. Patients show excellent response to low dose steroids with complete and sustained remissions. Rs3pe syndrome as paraneoplastic phenomenon since 1985, tumors have been descripted in association with rs3pe 1. Serum matrix metalloproteinase 3 in detecting remitting. It may present, as a paraneoplastic manifestation especially in older people who show a poor response to steroids. Case of remitting seronegative symmetrical synovitis with. Mccartys original diagnostic criteria 1 for rs3pe included seronegative symmetrical synovitis with pitting edema of hands, male predominance, old age, good response to. A diagnosis of remitting seronegative symmetrical synovitis with pitting edema syndrome rs3pe was made. Remitting seronegative symmetrical synovitis with pitting edema or rs3pe is a rare elderlyonset rheumatic syndrome. Rs3pe syndrome developing during the course of probable.
Indeed, reported here, tocilizumab treatment resulted in a remarkable suppression of clinical symptoms, accompanied by a reduction in mmp3 levels as well. Therefore, we started treatment with vancomycin 1 gday and. Rs3pe can be associated with neoplasia and various rheumatic conditions, suggesting that it may be. Rheumatica in view of the duration of treatment with steroids that is needed. It can present as an acute onset polyarthritis with associated pitting oedema of the extremities. The clinical features of the disease are characterized by bilatera we use cookies to enhance your experience on our website. Rs3pe is the short form of remitting seronegative symmetrical synovitis with pitting edema. Anticitrullinated protein antibodypositive rheumatoid. It is characterized by symmetrical distal pitting edema with synovitis of the hands and feet that is generally very responsive to lowdose glucocorticoids. Remitting seronegative symmetrical synovitis with pitting edema rs3pe and the syndrome of inappropriate antidiuretic hormone secretion siadh can be related to neoplasia, but the association between each of these syndromes and myeloma is rare, particularly in elderly adults. Over the years, several types of tumors have been described associated with the syndrome and. It is classically described as symmetrical involvement of both upper extremities.
Treatment of a patient with remitting seronegative. The patient was thus diagnosed with rs3pe syndrome, for which he satisfied. By continuing to use our website, you are agreeing to our use of cookies. Remitting seronegative symmetrical synovitis with pitting oedema. Another important characteristic of rs3pe syndrome is its association with. Rs3pe syndrome with positive rheumatoid factor reumatologia. Aug 29, 2008 rs3pe syndrome can be associated with both solid tumours like gastric, pancreatic and haematological malignancies like nonhodgkins lymphoma. Syndrome of remitting seronegative symmetrical synovitis. Antiinflammatory treatment with corticosteroids leads to prompt improvement. If no underlying disorder can be identified, this entity has an excellent prognosis and responds well to treatment. 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. Criteria used for diagnosis of rs3pe syndrome included sudden onset of painful diffuse swelling of both hands associated with pitting edema of the dorsa of the hands without other synovitis or evidence of disease, negative rheumatoid factor, absence of radiologic abnormalities, and resolution within 612 months without sequelae. Rs3pe, paraneoplastic syndrome, older people, polyarthritides.
Since acute cts can be the initial manifestation of rs3pe syndrome, as was the case in our patient, early detection and treatment are necessary. Rs3pe syndrome can be associated with both solid tumours like gastric, pancreatic and haematological malignancies like nonhodgkins lymphoma. Rs3 pe syndrome definition of rs3 pe syndrome by medical. Mmp3 was more indicative of rs3pe syndrome symptoms than crp. Is remitting seronegative symmetrical synovitis with pitting. Rs3pe syndrome developing during the course of probable toxic. The rs3pe syndrome that the patient developed during the clinical course of tss is a disease concept that was first advocated by mccarty et al. It commonly occurs in elderly individuals and is remitting, seronegative namely rheumatoid factornegative, symmetrical, and characterized by synovitis with pitting edema on the dorsum of the hands and feet. Disease bioinformatics research of rs3pe syndrome has been linked to edema, synovitis, pitting edema, remitting seronegative symmetrical synovitis with, arthritis. Syndrome of remitting seronegative symmetrical synovitis with. Patients with idiopathic rs3pe showed an excellent response to low doses of corticosteroids compared to the poor response to rs3pe in association with neoplasia 9. Most cases of remitting seronegative symmetrical synovitis with pitting edema syndrome are idiopathic, but some are secondary to malignancy, autoimmune disease, or neurodegenerative disorders.
Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare syndrome. Asymmetrical involvement had also been reported, but unilateral presentation is very rare. Here, we describe a 67yearold man with mds with refractory anemia who developed rs3pe syndrome 3 months after the diagnosis of mds. Rs3pe syndrome can be associated with both solid tumours like gastric 6, pancreatic 7 and haematological malignancies like nonhodgkins lymphoma 8. Jul 20, 2016 remitting seronegative symmetrical synovitis with pitting edema syndrome is characterized by symmetrical synovitis with pitting edema in the dorsum of the hands or feet. To investigate whether the remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome may represent a paraneoplastic disorder in a significant percentage of cases.
For this reason, the acr criteria may not be met early in the disease course in patients who subsequently develop typical rheumatoid arthritis. Remitting seronegative symmetrical synovitis with pitting edema. Maroteaux lamy syndrome is an autosomal recessive disease caused by deficiency of the lysosomal enzyme nacetylgalactosamine 4sulfatase arylsulfatase b which is involved in glycosaminoglycan gag degradation 1, 2. Daniel mccarty and coworkers in 1985, it was felt to be a distinct form of elderly or lateonset rheumatoid arthritis lora characterized by symmetrical synovitis of the hands and ankles with pitting edema, elevated acute phase reactants, negative rheumatoid factor rf. Rs3pe can be a disease and not a syndrome has been more and more evaluated. Here, we report a case of acute bilateral progressive cts caused by rs3pe syndrome. Although there are overlapping clinical manifestations between rs3pe, elderlyonset rheumatoid arthritis, and polymyalgia rheumatica, rs3pe has distinct characteristics. Myelodysplastic syndrome mds is characterized by infective hematopoiesis with possible transformation to leukemia. The erythema disappeared after diclofenac sodium administration. Acute progressive bilateral carpal tunnel syndrome associated.
Clinical characteristics of patients with remitting. The exact pathophysiology of rs3pe remains unknown. Sir, rs3pe is an inflammatory disorder of unknown aetiology that affects elderly persons 1. We report a patient with remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome and elevation of matrix metalloproteinase 3 mmp3. 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. It is estimated that no more than 10% of patients with pmr may have an rs3pe syndrome, and some authors think that rs3pe can be considered an integral part of the spectrum of the pmr manifestations. It was acute in onset, severe in intensity to such an extent that she was unable to make a. Remitting seronegative symmetrical synovitis with pitting oedema rs3pe syndrome. It usually presents as an acute, symmetric polysynovitis with edema of the dorsum of the hands and feet. Because rs3pe syndrome has recently been recognized as a potential paraneoplastic syndrome, we searched for malignancy. Rs3pe syndrome with iliopsoas bursitis distinguished from.
It can also occur as a paraneoplastic syndrome and can sometimes be a harbinger of malignancy. Case report open access rs3pe syndrome developing during the course of probable toxic shock syndrome. Rs3pe is a syndrome first described in 1985 as a distinct type of seronegative rheumatoid arthritis. 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. However, because the joint swelling and pitting edema did not improve, p. Jun 26, 2015 remitting seronegative symmetrical synovitis with pitting edema or rs3pe is a rare elderlyonset rheumatic syndrome. The differential diagnosis of rs3pe syndrome includes rheumatoid arthritis ra, complex. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome was first reported by mccarty et al. Rs3pe is listed in the worlds largest and most authoritative dictionary database of abbreviations and acronyms the free dictionary. Nivolumab induced remitting seronegative symmetrical. It is a rare clinical syndrome that occurs predominantly in elderly men and is. 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 negative serum rheumatoid factor. Rs3pe could be in some cases a paraneoplastic syndrome. Clinicians must recognize rs3pe syndrome when they come across it in connection with cases of asymmetric arthritis with pitting edema.
The rs3pe syndrome remitting seronegative symmetrical synovitis with pitting edema is a manifestation of rheumatoid arthritis in the elderly with a good prognosis. In this case report we discuss a case of rs3pe syndrome where the. Oct 01, 2012 remitting seronegative symmetrical synovitis with pitting oedema rs3pe was first described by mccarty et al. Pdf remitting seronegative symmetrical synovitis with. Large joint arthritis andor pitting oedema of the dorsum of feet coexisted in some patients. The study of rs3pe syndrome has been mentioned in research publications which can be found using our bioinformatics tool below. Remitting seronegative symmetrical synovitis with pitting edema rs3pe polyarthritis. Currently, rs3pe syndrome can be classified as a vascular endothelial. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome. In this syndrome, distal symptoms and signs, often of sudden onset, are pronounced, though careful musculoskeletal examination will. We present a case of rs3pe syndrome with positive rheumatoid factor rf that commenced as positive following the development of a tumour. Idiopathic remitting seronegative symmetrical synovitis with pitting. Treatment with prednisone, 25 mg daily, was initiated when obvious signs of infection.
Pdf on jun 30, 2017, ciro manzo and others published polymyalgia rheumatica in association with remitting seronegative sinovitis with pitting edema. Remitting seronegative symmetrical synovitis with pitting. Rs3pe syndrome, pleural effusions, pericardial effusions, vegf, il6. Letter to the editor case of remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome induced by nivolumab in a patient with advanced malignant melanoma naoko wada. Rs3pe syndrome can also be associated with diseases like malignance, polimyalgia. Contrastenhanced computed tomography cect showed a 2 cm mass with lowdensity centers with an enhanced rim in the left iliopsoas muscle which con. Although the study of additional cases is necessary, mmp3 seems to be more sensitive to rs3pe syndrome symptoms.
Increased serum concentration of il6 has been observed in patients with rs3pe 2, 3, and therefore il6 inhibition with tocilizumab might constitute a novel strategy for treatment of rs3pe. Rs3pe could be related to another, yet unknown hla type. Unilateral rs3pe in a patient of seronegative rheumatoid. Unilateral rs3pe syndrome volume 28 issue 2 june 20. Summary remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome is characterized by sudden onset of edema with swelling on the dorsum of the hands and by synovitis.
Rs3pe remitting seronegative, symmetric synovitis with pitting edema is a benign, seronegative syndrome, with an acute onset of pitting edema on the dorsum of both hands and feet, which affects predominantly peripheral joints such as wrists and ankles symmetrically. Rs3pe typically involves the joints of the extremities. The syndrome was reported to be associated with hla b7 3 and hla a2 haplotypes. It is a rare clinical syndrome that occurs predominantly in elderly men and is characterized by rapidonset symmetrical distal teno andor joint synovitis, marked pitting oedema over the joints involved, especially the dorsum of the hands and feet. Idiopathic remitting seronegative symmetrical synovitis with. Remitting seronegative symmetrical synovitis with pitting edema a subgroup of pts with rheumatoid arthritis with sudden onset, seronegativity for rheumatoid factors management aspirin, nsaids prognosis excellent.
Though its diagnostic criteria have been described by olive et al. The literature only includes a few cases of unilateral rs3pe syndrome,4,5 but in our opinion, the unilateral involvement of this syndrome is not as rare as has been reported. Myelodysplastic syndrome precedes the onset of remitting. Polymyalgia rheumatica in association with remitting.
Rs3pe syndrome remitting seronegative symmetrical synovitis with pitting oedema occurs mostly in elderly people over 60 years of age and is demonstrable on the dorsum of the hands. Onset of seven of the ten cases could be pinpointed almost to the hour. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare but wellreported clinical entity. Although rs3pe syndrome may exist as a paraneoplastic condition and be accompanied by various autoimmune diseases, there are currently no reports of rs3pe syndrome or rheumatoid.
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