Remitting seronegative symmetrical synovitis with pitting edema

Abstract

  Remitting Seronegative Symmetrical Synovitis with Pitting Edema（RS3PE）described for the first time in 1985 by McCarty et al. is characterized by an uncommon elderly-onset, bilateral, symmetric, tenosynovitis and pitting edema of extensor tendons at the wrist and at the feet.

  The levels of vascular endothelial growth factor（VEGF）, a cytokine able to increase vascular permeability and dilation, are significantly higher in RS3PE patients than in controls. The increased VEGF level is attributed to the increased vascular flow in the impaired joints.

  Although the C-reactive protein level and erythrocyte sedimentation rate were increased in this disease, it is seronegative for rheumatoid factor and antibodies against citrullinated peptides. Serum matrix metalloproteinase 3 concentration is elevated, especially in the patients with malignancies. Hand and foot magnetic resonance imaging and ultrasonography showed that extensor tenosynovitis was the responsible lesion for the edema in the subcutaneous and peritendinous soft tissue of the dorsum in both conditions equally. The remitting course and the absence of radiographic joint destruction differentiate RS3PE syndrome from rheumatoid arthritis.

  We have recently observed 9 cases of paraneoplastic RS3PE. The malignancies were solid, and the stomach, colon, breast, prostate and lung were involved. The most frequent histological type was adenocarcinoma.

  Its clinical symptoms and signs dramatically respond to 10-15mg/day prednisolone and remit within 1-2 weeks.