Remitting Seronegative Symmetrical Synovitis with Pitting Edema associated with Lung Malignancy:Case Report and Literature Review / 中国医学科学院学报

Remitting seronegative symmetrical synovitis with pitting edema(RS3PE),the inflammatory arthritis attacking mainly elderly males,is characterized by symmetrical synovitis with pitting edema of the dorsum of hands and feet and the absence of rheumatoid factor.RS3PE commonly accompanies malignant tumor,infections and other diseases.Here we report a case of RS3PE associated with lung malignancy and review other six cases to summarize the clinical features,treatment and prognosis.

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 syndrome: a clinical and outcome analysis of 14 cases and review of literature / 中华风湿病学杂志

Objective To analyze the clinical features and outcome of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome,and enhance the understanding of it.Methods Fourteen cases of RS3PE syndrome treated in the Department of Rheumatology and Immunology were analyzed retrospec-tively,including the clinical characteristics,laboratory data.Data were presented as -x±s.Results Fourteen patients(nine man,five women) with RS3PE were enrolled.Their age was (68±9) (range:52-78)years.The main clinical features were acute onset symmetrical edema in both hands and feet and polyarthritis.Polyarthritis were involved in hand joints in 14 patients,wrists in 13 patients,knees in 10 patients,ankles in 9 patients,and shoulders in 8.In laboratory examinations,the average value of erythrocyte sedimentation rate was (68±26) mm/l h and C-reactive protein was (49±41) mg/L.Mild anemia of normocytic-normochromic type and mild low level of serum albumin were frequent findings.Antinuclear antibody was present only in one patient at low titer (1∶20).Rheumatoid factor and other auto antibodies were all negative in patients.Before corticosteroid treatment,the MRI test was performed in 8 patients and revealed prominent synovitis and articular effusion.Two cases had bone erosions on MRI; five patients were fuond to have malignant tumors,three of them initially presented with RS3PE.Polyarthritis and edema were relieved after treated with low dose corticosteroids and DMARDs drugs.But those patients with cancer were easily to recurr.Conclusion RS3PE syndrome is relatively uncommon.It occurs predominantly in elderly men and is characterized by rapid-onset symmetrical polyarthritis,presence of pitting edema of both hands and feet.Erosive changes can be seen on MRI.Patients usually have dramatic response to low dose corticosteroids and DMARDs drugs.Patients should be closely followed as RS3PE is closely related to cancer.