Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare but wellreported clinical entity. Pdf remitting seronegative symmetrical synovitis with. Although the pathogenesis of rs3pe remains unknown, overproduction of il6 has been demonstrated to contribute to its development 2, 3. I finally found a rheumatologist, who, after taking sonogram and mris of wrists and hands, has concluded i have it. Carpal tunnel syndrome cts was suspected and confirmed by electromyography. Fever and edema disappeared 3 days after the treatment, so prednisolone was reduced to 18 mg. Remitting seronegative symmetrical synovitis with pitting edema listed as rs3pe. 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. Myelodysplastic syndrome mds is characterized by infective hematopoiesis with possible transformation to leukemia. Furthermore, the restless leg syndrome of our patient resolved in the following months. And now, its connected to the adobe document cloud. Remitting seronegative symmetrical synovitis with pitting oedema. Ab1034 the treatment approach for the management of remitting.
The rs3pe syndrome remitting seronegative symmetrical synovitis with pitting edema is a manifestation of rheumatoid arthritis in the elderly with a good prognosis. Magnetic resonance imaging mri was used to describe the anatomical structures affected by inflammation in pure rs3pe syndrome. S ir, rs3pe is an inflammatory disorder of unknown aetiology that affects elderly persons. Myelodysplastic syndrome precedes the onset of remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome. Adobe acrobat reader dc software is the free global standard for reliably viewing, printing, and commenting on pdf documents. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare clinical entity that is easily missed due to lack of knowledge. It dramatically responds to low doses of glucocorticoids. We herein report a 62yearold man with idiopathic pulmonary fibrosis who developed remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome during followup. Myelodysplastic syndrome precedes the onset of remitting. The objective of this study was to clarify the characterizations of polymyalgia rheumatica pmr and remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome. Vascular endothelial growth factor 165 vegf 165, tumour necrosis factor. 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.
Rs3pe syndrome as a first manifestation of bladder. Clinical characteristics of patients 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. Adobe acrobat reader dc download free pdf viewer for. The rs3pe syndrome remitting seronegative symmetrical synovitis with pitting edema is a manifestation of rheumatoid. 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. J med oncl ther 2016 olume 1 ssue 2 73 several months, as average.
Leprosy presenting as remitting seronegative symmetrical. Remitting seronegative symmetrical synovitis with pitting oedema syndrome, a rare inflammatory arthritis, commonly affects people in the older age group. Rs3pe syndrome presenting as vascular endothelial growth. An unusual case of remitting seronegative symmetrical. Remitting seronegative symmetrical synovitis with pitting edema rs3pe is characterized by symmetrical edema of the dorsal surfaces of the hands, a negative rheumatoid factor, and absence of bony erosions even in the presence of articular lesions. The case presented posed a complex diagnostic challenge. Rs3pe is a symmetrical synovitis of rapid installation, with pitting edema on the back of the hands, no joint destruction and the absence of rheumatoid factor, predominantly found in men over 50. Remitting seronegative symmetrical synovitis with pitting edema rs3pe polyarthritis. First, a presenting picture of rs3pe syndrome without skinneurologic complaints is rarely reported in leprosy.
Apr, 2018 remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome was first reported in 1985 by mccarty et al. The exact pathophysiology of rs3pe remains unknown. In the latter, the clinical picture of rs3pe developed after surgical intervention for the primary lesion. The aetiology of the disease is still not well known but we can classify it as a disease with characteristic clinical features. Later on, rs3pe syndrome classification criteria were proposed 5 including bilateral. One of the patients was positive for helicobacter pylori and the other had secondary bone metastases.
A diagnosis of remitting seronegative symmetrical synovitis with pitting edema syndrome rs3pe was made. Onset of seven of the ten cases could be pinpointed almost. Rs3pe syndrome developing during the course of probable toxic. We hereby report a case of unilateral rs3pe in a patient of seronegative rheumatoid arthritis which was. Rs3pe syndrome developing during the course of probable. It is a rare type of seronegative polyarthritis occurring in the. Rs3pe syndrome as a first manifestation of bladder carcinoma. Most cases of remitting seronegative symmetrical synovitis with pitting edema syndrome are idiopathic, but some are secondary to malignancy, autoimmune disease, or neurodegenerative disorders.
Leprosy typically manifests with skin and peripheral nerve involvement. Ga scintigraphy showed synovitis of the bilateral wrists. Remitting seronegative symmetrical synovitis with pitting oedema rs3pe was first described by mccarty et al. The paraneoplastic meaning of r3spe remitting seronegative.
It usually presents as an acute, symmetric polysynovitis with edema of the dorsum of the hands and feet. Unilateral rs3pe in a patient of seronegative rheumatoid. Rs3pe remitting seronegative symmetrical synovitis with pitting edema. Cantini f, salvarani c, olivieri i, benozzi l, macchioni l, nicolli l, et al. Therefore, we started treatment with vancomycin 1 gday and clindamycin 600 mgday, after which his fever rapidly remitted. The presence of swelling and pitting oedema of both hands figures 1 and 2 led to the diagnosis of remitting seronegative symmetrical synovitis with. The erythema disappeared after diclofenac sodium administration. Indeed, reported here, tocilizumab treatment resulted in a remarkable suppression of clinical symptoms, accompanied by a reduction in mmp3 levels as well. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation.
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. It is characterized by symmetrical distal pitting edema with synovitis of the hands and feet that is generally very responsive to lowdose glucocorticoids. Numerous additional cases have since been reported. Clinicians must recognize rs3pe syndrome when they come across it in connection with. Pdf syndrome of remitting seronegative symmetrical. Here, we describe a 67yearold man with mds with refractory anemia who developed rs3pe syndrome 3 months after the diagnosis of mds. It commonly has a benign course leading to remission but in some cases has been associated with neoplastic, other rheumatic, or comorbid. 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. Full texthtml download pdf 1883k download meta ris compatible with endnote, reference manager, procite, refworks. Remitting seronegative symmetrical synovitis with pitting oedema syndrome has only been described once in a. Out of these cookies, the cookies that are categorized as necessary are stored in your browser as they are essential for the working of basic functionalities of the website. To investigate whether the remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome may represent a paraneoplastic disorder in a significant percentage of cases. It is classically described as symmetrical involvement of both upper extremities. It is remitting seronegative symmetrical synovitis with pitting edema.
As controls, serum samples from 26 healthy volunteers, 12 patients with rheumatoid arthritis, 10 patients with systemic lupus erythematosus. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome. On the other hand, rs3pe syndrome was diagnosed in 3 men 76, 76, and 81 years old. Rs3pe can be associated with neoplasia and various rheumatic conditions, suggesting that it may be. These symptoms show a good response to lowdose corticosteroids, and remission can be maintained. Comparison between polymyalgia rheumatica and remitting.
A case of paraneoplastic remitting seronegative symmetrical. Rs3pe is an acute onset polyarthritis syndrome which can occur idiopathically or as paraneoplastic complication in a malignancy. Anemia of chronic disease in patients with rheumatoid arthritis. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome is characterized by symmetrical synovitis with pitting edema in the dorsum of the hands or feet, predominantly involving the hands. We report two cases of paraneoplastic remitting seronegative symmetrical synovitis with pitting edema rs3pe associated with prostatic adenocarcinoma. Idiopathic remitting seronegative symmetrical synovitis. Antiinflammatory treatment with corticosteroids leads to prompt improvement. 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 edema of the dorsum of the hands or the feet. They range from arthralgiaarthritis in reactional states to full mimics of systemic rheumatic diseases. Its relapse is extremely rare in the benign forms and, when present, it presents only after several months 5. The term synovitis is used due to the symmetric polysynovitis of the joints and tendon sheaths of the fingers, associated to edema. It commonly has a benign course leading to remission but in some cases has been associated with neoplastic, other rheumatic, or comorbid diseases. 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.
However, the number of patients with rs3pe syndrome is quite small in this study, thereby suggesting that a much larger survey. Currently, rs3pe syndrome can be classified as a vascular endothelial growth factor vegfassociated disorder. Remitting seronegative symmetrical synovitis with pitting oedema syndrome has only been described once in a patient. Rs3pe is a syndrome first described in 1985 as a distinct type of seronegative rheumatoid arthritis. 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.
Two patients developed t lymphoma and one myelodysplastic syndrome. The rate of polymyalgia rheumatica pmr and remitting. Asymmetrical involvement had also been reported, but unilateral presentation is very rare. Case of remitting seronegative symmetrical synovitis with. It has not been reported as an association with rs3pe or lung cancer. It may occasionally be the harbinger of an underlying malignancy. It was formerly considered as a subset of rheumatoid arthritis ra, but is now regarded as a distinct disease syndrome. Rs3pe syndrome remittive symmetrical seronegative synovitis with pitting edema was first described by maccarthy in 1985. Aug 29, 2008 rs3pe syndrome can be associated with both solid tumours like gastric, pancreatic and haematological malignancies like nonhodgkins lymphoma. Remitting symmetric seronegative synovitis with pitting. The aetiology of the disease is still not well known but we can classify it. Although there are overlapping clinical manifestations between rs3pe, elderlyonset rheumatoid arthritis, and polymyalgia rheumatica, rs3pe has distinct characteristics. Remitting seronegative symmetrical synovitis with pitting.
Carpal tunnel syndrome caused by remitting seronegative. Remitting symmetric seronegative synovitis with pitting edema. Pdf an unusual case of remitting seronegative symmetrical. Jun 26, 2015 remitting seronegative symmetrical synovitis with pitting edema or rs3pe is a rare elderlyonset rheumatic syndrome. 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. The paraneoplastic meaning of r3spe remitting seronegative simmetrical synovitis with pitting edema syndrome ciro manzo internal and geriatric department, chief of geronthorheumatological, outpatient clinic, mariano lauro hospital, santagnello, naples, italy. Rs3pe, paraneoplastic syndrome, older people, polyarthritides.
After the diagnosis of rs3pe syndrome was made, systemic steroid was given and fever, edema and liver function. Acute progressive bilateral carpal tunnel syndrome associated. 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 was first described in 1985 by mccarty et al. 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. Patients with rs3pe syndrome should be screened for hematological disorders that. The paraneoplastic meaning of r3spe remitting seronegative simmetrical synovitis with pitting edema syndrome. Remitting seronegative symmetrical synovitis with pitting oedema rs3pe syndrome. The paraneoplastic meaning of r3spe remitting seronegative simmetrical synovitis with pitting edema syndrome, ciro manzo. Its the only pdf viewer that can open and interact with all types of pdf content, including. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome is a rare clinical entity characterized by the sudden onset of inflammatory arthritis and marked pitting edema on. A 73yearold man presented with paresthesias of the fingertips and weakness of the abductor pollicis brevis muscle and the opponens pollicis muscle of both hands. Since acute cts can be the initial manifestation of rs3pe syndrome, as was the case in our patient, early detection and treatment are necessary.
Pdf remitting seronegative symmetrical synovitis with pitting oedema syndrome. If no underlying disorder can be identified idiopathic rs3pe, this entity has an excellent prognosis and responds well to treatment. Nivolumab induced remitting seronegative symmetrical. The clinical features of the disease are characterized by bilateral pitting oedema of the hands and sudden onset of polyarthritis. Pdf remitting seronegative symmetrical synovitis with pitting edema rs3pe is a rare form of. When compared with pmr, the rate of rs3pe syndrome was approximately onethird. Remitting seronegative symmetrical synovitis with pitting edema rs3pe, also described as puffy edematous hand syndrome, is a rare rheumatological condition characterized by symmetrical tenosynovitis of the upper andor lower extremities with acute onset of pitting edema of the dorsa of the hands and thus gives the appearance of boxing. Rs3pe is a heterogeneous syndrome the clinical history, presence of. 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. 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. A case of remitting seronegative symmetrical synovitis with.
Rs3pe syndrome remitting symmetrical seronegative synovitis with pitting edema was first described by mc carthy in. Remitting seronegative symmetrical synovitis with pitting oedema 73. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome was first reported by mccarty et al. Treatment of a patient with remitting seronegative. Rs3pe is listed in the worlds largest and most authoritative dictionary database of abbreviations and acronyms. In addition to the isolated or pure type which probably forms part of the clinical spectrum of polymyalgia rheumatica, inflammatory swelling with pitting ede. Rs3pe syndrome has also been associated with malignancies, 10, 16 and, therefore, screening for potential malignancies is required at the initial diagnosis. Patients with idiopathic rs3pe showed an excellent response to low doses of corticosteroids compared to the poor response to rs3pe in association with neoplasia. 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. It can also occur as a paraneoplastic syndrome and can sometimes be a harbinger of malignancy.
Syndrome of remitting seronegative symmetrical synovitis with pitting edema rs3pe, authorfatma paksoy and turgay ulas and emrah erkan mazi and ayda batuan damar and fatih borlu, year2010. Ab1034 the treatment approach for the management of. After the diagnosis of rs3pe syndrome was made, systemic steroid was given and fever, edema and. It is characterized by symmetrical polyarthritis associated with pitting edema of. Remitting seronegative symmetrical synovitis with pitting edema. Syndrome of remitting seronegative symmetrical synovitis.
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. 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. He is giving me methotrexate, which scares the heck out of me. 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. Pdf remitting seronegative symmetrical synovitis with pitting. The concept of rs3pe syndrome could explain such as an impressive clinical course. This website uses cookies to improve your experience while you navigate through the website. For months i ran around do doctors in florida and no one could figure it out. Objective to 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 edema rs3pe syndrome is characterized by symmetrical synovitis predominantly involving the wrists, and is associated with marked pitting edema of the dorsum of the hands. Patients show excellent response to low dose steroids with complete and sustained remissions.
Background remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome is an acute inflammatory polyartritis and palpable pitting edema of the elderly patients. It can present as an acute onset polyarthritis with associated pitting oedema of the extremities. Remitting seronegative symmetrical synovitis with pitting edema rs3pe syndrome was first reported in 1985 by mccarty et al. The syndrome was reported to be associated with hla b7 3 and hla a2 haplotypes.
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