RS3PEIs Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) a Subset of Rheumatoid Arthritis?
Section snippets
Methods
A PubMed and OVID database search of the English language literature between January 1985 and July 2008 was performed using the keyword RS3PE in combination with neoplasia, rheumatic diseases, etiology, elderly-onset RA, or pathogenesis. All relevant English language articles were reviewed and references screened for additional articles. The review is supplemented with the report of a patient with RS3PE.
Case Report
A 70-year-old woman presented to the Rheumatology Clinic in the University of California at Los Angeles, California Medical Center with rapid-onset painful and swollen hands, ankles, and feet of 2 months' duration and a painful right shoulder. Morning stiffness was most severe and lasted all day. She complained of fatigue without fever, rash, or weight loss. Malignancy workup was negative including computed tomography of the thorax, abdomen, and pelvis, and colonoscopy because she had an
Discussion
RS3PE is a distinct syndrome/entity rather than a subset of RA. RS3PE always has pitting edema, negative RF, absence of bony erosions, generally has an excellent therapeutic response to a small dose of glucocorticoid, and lacks the HLADRB1 genotype that is present in both early- and late-onset RA. More importantly, RS3PE appears to be associated with a significantly higher rate of neoplasia than RA and to have a different neoplastic pattern. Serum VEGF levels are substantially higher than in
Acknowledgment
The authors are thankful to Dr. John Fitzgerald for constructive comments during manuscript preparation.
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The authors have no conflicts of interest to disclose.