Background Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is an acute edematous polyarthritis of the elderly subjects. Although an initial response to corticosteroids is very good, the further outcome of RS3PE syndrome remains to be elucidated.
Objectives We have tried to investigate the further outcome in patients with RS3PE syndrome.
Methods This is a retrospective multicenter study held in Nagasaki prefecture, Japan. We have consecutively registered the patients with RS3PE syndrome fulfilling the following criteria: (1) bilateral pitting edema of both hands or feet, or both, (2) sudden onset of polyarthritis, (3) age >50 years, (4) seronegative for rheumatoid factor (RF). The total of 29 cases, between October 2003 and September 2012, were diagnosed as RS3PE syndrome and registered in the present study. Patients gave their informed consent to be subjected to the protocol and the outcome was evaluated by the medical records for 1 year after initial introduction of corticosteroids.
Results Although an excellent response to initial corticosteroids was noted in all the 29 patients, twenty-five out of 29 patients (86.2%) still received corticosteroids at 1 year and 13 out of 29 patients (44.8%) received prednisolone >5mg/day. Disease-modifying anti-rheumatic drugs including methotrexate were required in three patients (10.3%), furthermore, the elevation of CRP was still noted in 8 patients (27.6%) at 1 year. Accordingly, neoplasm was found in 12 patients (41.2%) and 3 died during 1 year. None of the RS3PE patients without neoplasm died during 1 year. Although there was no statistical difference, corticosteroids tended to be continued in the RS3PE patients with neoplasm (eleven out of 12: 91.7%) as compared with those without neoplasm (fourteen out of 17: 82.4%) during this follow up periods.
Conclusions The present data suggest that the outcome of RS3PE syndrome may be variable and appears to be worse than expected. Coexistence of neoplasm might influence the outcome of these patients.
Arima K, Origuchi T, et al. RS3PE syndrome presenting as vascular endothelial growth factor associated disorder. Ann Rheum Dis. 2005 64(11):1653-5.
Origuchi T, et al. High serum matrix metalloproteinase 3 is characteristic of patients with paraneoplastic remitting seronegative symmetrical synovitis with pitting edema syndrome. Modern Rheumatol. 2012 22(4):584-8.
Disclosure of Interest None declared
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