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RS3PE syndrome. The relation with HLA B7
  1. COLIN PEASE,
  2. BIPIN BHAKTA
  1. Department of Rheumatology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX
    1. JEAN DUDLER,
    2. JEAN-CHARLES GERSTER,
    3. ALEXANDER SO
    1. Service de Rheumatologie, Médecine Physique et Réhabilitation, CHUV, 1011 Lausanne, Switzerland

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      We agree with Dudler et al 1 that RS3PE is one way in which late onset polyarthritis can present. However, we believe it is more a clinical feature indicating a good prognosis rather than a specific syndrome. As they have admirably summarised its occurrence in a number of other conditions, in which the only linking feature is that the patients tend to be elderly, would support this view. The association with HLA B7 is as yet not proved, the incidence varying with the population screened (table 1).

      Table 1

      Frequency of HLA B antigens in patients with RS3PE

      References

      Authors' reply

      We are grateful to Drs Pease and Bhakta for their interesting comments on the relation of RS3PE and HLA B7. We agree with them that the association with HLA B7 is not yet proved, and that actually data from diverse groups tend to speak against it. We also found that their prospective study looking at pitting oedema in various subsets of late onset rheumatoid arthritis as a good and independent factor of good prognosis was very interesting.1-1 Nevertheless, a syndrome is simply a group of signs and symptoms occurring together and characterising a particular abnormality. We believe that it is still useful to define RS3PE as a specific syndrome particularly regarding its excellent prognosis as compared with the other affections responsible for pitting oedema of the hands.1-2 The fact that HLA B7 prevalence is perhaps not increased in RS3PE does not bother us. RS3PE could be related to another, yet unknown HLA type. Furthermore, specific overprevalence of an HLA type is not a requisite to define a specific syndrome or disease. Both rheumatoid arthritis and polymyalgia rheumatica have been related to HLA DR4, but nobody would argue that they represent different diseases.

      References

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