RT Journal Article
SR Electronic
T1 Remitting seronegative symmetrical synovitis with pitting edema following intravesical bacillus Calmette-Guérin instillation.
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1699
OP 1701
VO 28
IS 7
A1 S Mouly
A1 F Berenbaum
A1 G Kaplan
YR 2001
UL http://www.jrheum.org/content/28/7/1699.abstract
AB Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare syndrome of undetermined etiology occurring in the elderly. We describe the first case of RS3PE in a HLA-B27 positive 65-year-old man following intravesical bacillus Calmette-Guérin (BCG) instillation for bladder carcinoma. He developed symmetrical arthritis and synovitis involving wrists, knees, ankles, and metatarsophalangeal joints, with marked pitting edema of the dorsa of both hands and feet, fever, and elevated acute phase reactants. Right knee effusion revealed nonspecific sterile inflammatory fluid. He responded dramatically to nonsteroidal antiinflammatory drugs. BCG instillation may have triggered active symmetrical synovitis via local T cell activation and a T-helper-1 (Th-1)/Th-2 inflammatory profile.