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AB1034 The Treatment Approach for the Management of Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Syndrome
  1. M. Calis1,
  2. I. Cuce1,
  3. O. Akgul2,
  4. E. Gungor Cuce1,
  5. V. Candan1
  1. 1Department of Rheumatology, Erciyes University Medical School, Kayseri
  2. 2Department of Rheumatology, Celal Bayar Üniversitesi, Manisa, Turkey


Background Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is an acute inflammatory polyartritis and palpable pitting edema of the elderly patients. It dramatically responds to low doses of glucocorticoids. It commonly has a benign course leading to remission but in some cases has been associated with neoplastic, other rheumatic, or comorbid diseases.

Objectives We have tried to determine a treatment approachin RS3PE

Methods A systematic MEDLINE search including articles published in English language between 1990 and December 2013 was performed. The search terms included “Remitting seronegative symmetrical synovitis with pitting edema”, “Remitting seronegative syndrome with pitting edema” and “RS3PE”. We included case reports and clinical trials which providing details regarding the clinical presentation, management and prognosis of patient(s) with newly or previously diagnosed RS3PE.

Results In December 31, 2013, 120 hits were found in MEDLINE search. One-hundred and seventy-four patients (121 male and 51 female) with RS3PE were identified. Patients with idiopathic and related benign conditions with RS3PE (approximately %75 of patients) showed a perfect response to low doses of steroids (0-10 mg oral prednisolone in %15 of patients, 11-20 mg oral prednisolone in almost %60 of patients, 21-30 mg oral prednisolone in %15 of patients, 31-40 mg oral prednisolone or intra-articular steroid administration in a few cases such as gouty or sarcoidosis) and the disease remission in withdrawal of steroid therapy (approximately 18 months). The patients with neoplasia (approximately %20, the most common causes were solid and hematological malignancies) showed a poor response to low dose steroids or relapse. Disease-modifying antirheumatic drugs (DMARDs) have generally been effective, especially hydroxychloroquine, required to be unresponsive to steroid treatment or relapse or avoid used of steroids due to comorbid diseases in a few patients with RS3PE (%15 of patients). Non-steroidal anti-inflammatory drugs (NSAIDs) usually provide symptomatic relief. One patient with RS3PE, developed complications related to long-term corticosteroid use and successful treatment with a humanized anti-interleukin-6 receptor antibody, tocilizumab was received.

Conclusions The present data suggest that oral administration of low-dose corticosteroids, such as 10-20 mg oral prednisolone, have to initial treatment of choice for patients with RS3PE syndrome, regardless of the related disease. Hydroxychloroquine can be used with a low-dose steroid to avoid complications of steroid therapy. Tocilizumab can be effective in selected patients. Age-appropriate cancer screenings are sufficient in patients with RS3PE and treatment of malignancy is critical


  1. McCarty DJ, O'Duffy JD et al. Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE Syndrome). JAMA 1985; 254: 2763–2767.

  2. Tanaka Ti Hagihara K et al. Treatment of patient with remitting seronegative, symmetrical synovitis with a pitting oedema with humanized anti-interleukin-6 receptor antibody, tocilizumab. Rheumatology (Oxford). 2010 Apr;49(4):824-6.

Disclosure of Interest None declared

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