Síndrome RS3PE (sinovitis simétrica seronegativa remitente con edema) como manifestación paraneoplásica de mesotelioma: reporte de un caso y revisión de la literatura / Remitting seronegative symmetrical synovitis with pitting oedema as a paraneoplastic manifestation of mesothelioma: A case report and review of the literature

RESUMEN El síndrome RS3PE (sinovitis simétrica seronegativa remitente con edema) fue descrito por McCarty (1985) como una forma benigna de artritis reumatoide de inicio en hombres mayores de 70 arios, con compromiso simétrico y asociada a edema de manos y pies. El enfoque de la poliartritis aguda en el adulto mayor debe incluir el síndrome RS3PE, en el que la pobre respuesta a esteroides y el compromiso multisistémico orientan hacia una naturaleza paraneoplásica, principalmente tumores sólidos (adenocarcinoma gástrico y pancreático), linfomas y leucemias. Se presenta el caso de un paciente con RS3PE como manifestación paraneoplásica de mesotelioma, una manifestación rara en este tipo de tumor.

A B S T R A C T Remitting seronegative symmetrical synovitis with pitting oedema (RS3PO) was described by McCarty (1985), as a benign form of rheumatoid arthritis that onset in men older than 70 years (80% of cases), with symmetrical and associated involvement of oedema of hands and feet. The approach of acute polyarthritis in the elderly should include the RS3PO syndrome, where poor steroid response and multisystem involvement oriented towards paraneoplastic nature, mainly with solid tumours (gastric and pancreatic adenocarcinoma), lymphomas and leukaemia. The case is presented of a patient with RS3PO as a paraneoplastic manifestation of mesothelioma, which is rare in this type of tumour.

Síndrome RS3PE en paciente con cáncer de próstata en estadio IV / RS3PE Syndrome in a Patient with Stage IV Prostate Cancer

La polisinovitis aguda edematosa benigna del anciano, también llamada síndrome RS3PE (acrónimo de remitting seronegative symmetrical synovitis with pitting edema), es una enfermedad reumatológica heterogénea que forma parte de las artritis inflamatorias y es de causa desconocida. Se presenta de forma exclusiva en la población de adultos mayores con afección poliarticular asociada a edema, tumefacción y limitación funcional que tiene por lo general buen pronóstico. Se describe el caso de un hombre de 70 años que cumple con seis de los siete criterios diagnósticos para esta enfermedad(AU)

Acute benign edematous polysynovitis in the elderly, also called RS3PE syndrome (acronym for remitting seronegative symmetrical synovitis with pitting edema), is a heterogeneous rheumatologic disease that is part of inflammatory arthritis and whose cause is unknown. It is presented exclusively in the population of aged adults with polyarticular affection associated with edema, swelling and functional limitation and has, in general, a good prognosis. We describe the case of a 70-year-old man who presents six of the seven diagnostic criteria for this disease(AU)

Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome: A Case Report

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare condition that occurs in elderly individuals. It is characterized by sudden onset of bilateral symmetrical distal tenosynovitis that accompanied by obvious swelling of the hand with pitting edema and absence of rheumatoid factor (RF). This disease entity sometimes presented as overlap syndrome with other rheumatic diseases and needed to be differentiated from those. However, if the diagnosis is confirmed, the response to steroid is good. The purpose of this report is to describe the case of RS3PE syndrome presented with bilateral hand dorsum edema in a middle-aged woman.

Remitting seronegative symmetrical synovitis with pitting edema:a retrospective analysis of 8 cases / 基础医学与临床

Objective To investigate the clinical features of Remitting Seronegative Symmetrical Synovitis with Pitting Oedema(RS3PE),especially it’s association with malignancy. Methods The clinical data of eight RS3PE patients hospitalized during Jan 2003 and June 2007 in Peking Union Medical College Hospital were reviewed. The clinical characteristics, laboratory tests, response to treatment as well as the outcome were studied. Among the 8 patients, five were male and 3 were female,the mean age of RS3 PE onset was 60.9 (38～79yr). 5 had idiopathic RS3PE without underlying disease, and 3 presented associated neoplasm. Results All patients had symmetrical polyarthritis and pitting edema on the dorsum of hands and/or feet. Extra-articular symptoms were more conspicuous in patients complicated by neoplasm. Serum RF、AKA、APF and anti-CCP antibody were all negative. antinuclear antibodies (ANA) was positive with low titer in five cases. Hand and foot radiographs did not show bone erosion in all cases. After steroid and/or immunosuppressive treatment, 2 cases exhibited persistent remission of articular symptoms and edema, whereas relapses occurred 6, 7 and 36 months respectively after the initial diagnosis in 3 cases who had been pathologically confirmed as having Non-Hodgkin-Lymphoma and thereby received periodical chemotherapy. Conclusion RS3PE is a group of clinical manifestations with prominent heterogeneity, therefore intensive follow-up is necessary, and the presence of systemic symptoms/ signs in RS3PE patients alert the physician for the potential concomitant malignancy.

Sjogren's Syndrome Presenting as Remitting Seronegative Symmetric Synovitis with Pitting Edema(RS3PE)

Remitting seronegative symmetric synovitis with pitting edema (RS3 PE) syndrome is characterized by symmetrical and acute synovitis, pitting edema, the absence of rheumatoid factor, increased acute phase reactants, lack of bony erosions on radiography, and benign and short clinical course. Half of all patients with Sjogren's syndrome experience arthritis during the disease course. We here describe the first case of Sjogren's syndrome presenting as RS3PE. She had swelling in knees, ankles, and wrists. After then the swelling spread to her lower legs, feet, face, and both hands. She was admitted to another hospital and was suspected of lupus or rheumatoid arthritis. Three months later, she had dry mouth and had lower lip biopsy. She was admitted to this hospital due to development of swelling in face and lower legs for 3 days. On physical examination, she had pitting edema in both hands and feet dorsum. Laboratory test showed elevated erythrocyte sedimentation rate, positivity of rheumatoid factor, anti-nuclear antibody, and anti-Ro antibody. There was no erosion in the hands radiography. Schirmer's test and lip biopsy was compatible with Sjogren's syndrome. She was diagnosed RS3 PE and Sjogren's syndrome. She was begun with prednisolone and her symptoms improved gradually.

A case of remitting seronegative symmetrical synovitis with pitting edema / 대한내과학회지

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare form of seronegative polyarthritis which is characterized by sudden onset of a symmetrical and peripheral polysynovitis, prominent pitting edema of both hands in elderly patient. It has a benign course and remits completely after steroid treatment. We describe a 77-year-old Korean man of RS3PE syndrome He presented with sudden onset polyarthritis and pitting edema of the dorsum of both hands and both feet. Rheumatoid factor was negative and erythrocyte sedimentation rate was high. Bone scintigraphy showed increased uptake in both wrist, knee, and ankle joints. His synovitis and pitting edema completely disappeared after steroid treatment.

RS3PE syndrome secondary to malignant lymphoma:A case report / 第二军医大学学报

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a syndrome associated with many conditions, including malignant neoplasms. One case T-cell malignant lymphoma whose first manifestation was RS3PE syndrome is reported, and the related literature is reviewed. RS3PE syndrome can be classified as primary and secondary one. The secondary RS3PE syndrome may not be a specific disease, and its prognosis depends on the primary disorders. The RS3PE syndrome associated with malignant neoplasms is called paraneoplastic RS3PE syndrome. Systemic symptoms and signs, eosinophilia and high lactate dehydrogenase (LDH) may indicate the possible presence of malignant lymphoma.

A Case of Remitting Seronegative Symmetrical Synovitis with Pitting Edema(RS3PE) Syndrome / 대한류마티스학회지

RS3PE is used to describe patients who have peripheral seronegative polyarthritis and pitting edema, especially in a man older than 60. It is characterized by sudden onset, high sedimentation rate, lack of bony erosion, remission within 18 months and good prognosis. Whether the RS3PE is a unique disease or syndrome has long been discussed, but conclusion was not obtained. We describe a 72 year old man of RS3PE with a review of the literature.