Extended reports
Remitting seronegative symmetrical synovitis with pitting oedema
(RS3PE) syndrome: a prospective follow up and magnetic resonance
imaging study
a Unità
Reumatologica, 2nd Divisione di Medicina, Ospedale di Prato, Prato,
Italy, b Servizio di Reumatologia, Azienda Ospedaliera
Arcispedale S Maria Nuova, Reggio Emilia, Italy, c Servizio
di Reumatologia, d and
Servizio di Radiologia, e Azienda Ospedaliera, Ospedale S Orsola-Malpighi,
Bologna, Italy
Correspondence to: Dr F Cantini, Unità Reumatologica, 2nd Divisione di Medicina, Ospedale di Prato, Piazza Ospedale N 1, 59100 Prato, Italy.
Accepted for publication 7 January 1999
OBJECTIVE
To
determine the clinical characteristics of patients with "pure"
remitting seronegative symmetrical synovitis with pitting oedema
(RS3PE) syndrome, and to investigate its relation with polymyalgia
rheumatica (PMR). Magnetic resonance imaging (MRI) was used to describe
the anatomical structures affected by inflammation in pure RS3PE syndrome.
METHODSA prospective
follow up study of 23 consecutive patients with pure RS3PE syndrome and
177 consecutive patients with PMR diagnosed over a five year period in
two Italian secondary referral centres of rheumatology. Hands or feet
MRI, or both, was performed at diagnosis in 7 of 23 patients.
RESULTSAt inspection
evidence of hand and/or foot tenosynovitis was present in all the 23 patients with pure RS3PE syndrome. Twenty one (12%) patients with PMR
associated distal extremity swelling with pitting oedema. No
significant differences in the sex, age at onset of disease, acute
phase reactant values at diagnosis, frequency of peripheral synovitis
and carpal tunnel syndrome and frequency of HLA-B7 antigen were present
between patients with pure RS3PE and PMR. In both conditions no patient
under 50 was observed, the disease frequency increased significantly
with age and the highest frequency was present in the age group 70-79
years. Clinical symptoms for both conditions responded promptly to
corticosteroids and no patient developed rheumatoid arthritis during
the follow up. However, the patients with pure RS3PE syndrome were
characterised by shorter duration of treatment, lower cumulative
corticosteroid dose and lower frequency of systemic signs/symptoms and
relapse/recurrence. Hands and feet MRI showed evidence of tenosynovitis
in five patients and joint synovitis in three patients.
CONCLUSIONThe
similarities of demographic, clinical, and MRI findings between RS3PE
syndrome and PMR and the concurrence of the two syndromes suggest that
these conditions may be part of the same disease and that the
diagnostic labels of PMR and RS3PE syndrome may not indicate a real
difference. The presence of distal oedema seems to indicate a better prognosis.
© 1999 by Annals of the Rheumatic Diseases
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