RS3PERemitting Seronegative Symmetrical Synovitis with Pitting Edema
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This rapid response to the corticosteroid therapy verified our RS3PE syndrome diagnosis.
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.
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.
We should always keep the possibility of RS3PE in all elderly patients presented with acute onset polysynovitis and pitting edema.
Table-1: Comparison between Rheumatoid Arthritis (RA); Polymyalgia Rheumatic (PMR) and Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3P) Feature RA PMR RS3PE Onset Gradual/chronic Sudden Acute/Sudden Sex F>M F>M M>F Age at onset 3rd 5th 7th 6th 9th (decade) Synovitis present Mild Very severe Pitting edema Unusual, if ++ occurs usually asymmetrical, due to joint capsule destruction RA factor + HLA association DR1, DR4 DR3, DR4 HLA B7 Response to High doses High dose Low dose steroid
In 1985, McCarty first described RS3PE in JAMA [1].
Over the next few years there were numerous case reports and case series focussing on RS3PE.
The pathogenesis of RS3PE has not yet been fully explored.
RS3PE diagnosis in the presented case was based on the following: male gender and age of 58 years, symmetric pitting edema and sudden-onset polyarthritis, non-observation of erosion on radiographs, and dramatic and rapid clinical and laboratory response to low-dose corticosteroid treatment within one week.
Response of RS3PE to NSAID treatment is not good (1).
Yapilan bir arastirmada RS3PE ile PMR'li hastalar arasinda demografik, klinik ve immunolojik bir fark gozlenmemistir.
Temelde yasanan sikinti PMR'yi gec baslangicli RA, osteoartrit, inflamatuvar miyopatiler, maligniteler, RS3PE, omuzda dejeneratif rotator manson sorunlari ile ayirici taninin yapilmasidir.