Abstract
The pleurisy of SLE or RA is often reported, however that of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is rare. We report an elderly case of RS3 PE syndrome with bilateral pleural effusions, impeding differential diagnosis of infection.
An 83-year-old woman was diagnosed “rheumatoid arthritis” in another clinic and treated by a 5mg daily dose of oral prednisolone for four years. She was admitted to our hospital because of acute onset of polyarthralgia, edema of the both hands and feet, and high fever. CRP was markedly elevated. Rheumatoid factor was weakly positive, although anti-CCP was negative. Ga-scintigraphy showed uptake in shoulders and wrists, however bone erosion was not found by plain radiography. The pleural effusion was in large quantities without invasion of lung. Effusion containing many neutrophils was exudative and negative for rheumatoid factor, bacteria, and malignant cells.
It was difficult to discriminate from infection. With a 20mg daily dose of oral prednisolone, remission of polyarthritis and pitting edema occurred, with a coincidental decrease of pleural effusions, leading to the diagnosis of RS3PE syndrome. Her symptoms and laboratory signs of inflammation improved and she was discharged.
RS3PE syndrome is considered to be one of the elderly disorders which present promptly as polyarthritis and edema with pleurisy.
