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SAT0533 Early Diagnosis is Associated with the Less Flair in Patients with Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Syndrome
  1. T. Origuchi1,2,
  2. K. Arima2,
  3. M. Umeda2,
  4. S.-Y. Kawashiri2,
  5. T. Koga2,
  6. K. Ichinose2,
  7. M. Tamai2,
  8. H. Nakamura2,
  9. T. Miyashita3,
  10. K. Fujikawa4,
  11. A. Mizokami4,
  12. N. Iwanaga5,
  13. M. Furuyama6,
  14. M. Nakashima7,
  15. T. Aramaki8,
  16. Y. Ueki8,
  17. Y. Kawabe9,
  18. T. Fukuda10,
  19. K. Eguchi11,
  20. A. Kawakami2
  1. 1Department of Rehabilitation Sciences
  2. 2Department of Rheumatology, Nagasaki University, Nagasaki
  3. 3Department of Rheumatology, Miyashita Rheumatology Clinic, Omura
  4. 4Department of Rheumatology, Isahaya Sogo Hospital, Isahaya
  5. 5Department of Rheumatology, Nagasaki Medical Center, Omura
  6. 6Department of Rheumatology, Nagasaki Kita Hospital, Togitsu
  7. 7Department of Rheumatology, Nagasaki Atomic Bomb Hospital, Nagasaki
  8. 8Department of Rheumatology, Sasabo CHUO Hospital, Sasebo
  9. 9Department of Rheumatology, Ureshino Medical Center, Ureshino
  10. 10Department of Rheumatology, Kurume University Medical Center, Kurume
  11. 11Department of Rheumatology, Sasebo Munincipal Hospital, Sasebo, Japan


Background Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) syndrome is first described by McCarty et al. in 1985. We had previously analyzed the characteristics of RS3PE syndrome and found that the diagnosis is sometimes delayed and the flair is often found during the first year of follow-up1.

Objectives To investigate whether the delay of diagnosis is associated with the flair in patients with RS3PE syndrome.

Methods A retrospective rheumatology multicenter study has been conducted in Nagasaki prefecture, Japan, toward 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. The patients, diagnosed as RS3PE syndrome, were consecutively enrolled between November 2005 and October 2014, and subjected to investigate the association of the delay of diagnosis with the flair during the first year of follow-up from medical records. The date of diagnosis was defined as the introduction of prednisolone and we have divided the 39 patients according to the duration from disease onset to the diagnosis: early diagnosis group less than 1 month whereas delayed diagnosis group required more than 1 month until diagnosis. The flair is defined as the increment of prednisolone dosages.

Results Fifty-three patients fulfilled the above criteria of RS3PE syndrome. Of these, 14 patients were excluded owing to a lack of clinical data and 39 patients were included. They were 22 male (55.2%) and 17 female (44.8%) patients. The mean age was 78.9±6.3 years (65-89). Fourteen patients were classified as the early diagnosis group whereas the remaining 25 patients as the delayed diagnosis group, respectively. All the 39 patients showed an initial good response toward prednisolone, however, 12 patients (30.1%) experienced the flair during the first year. No significant differences were noted in C-reactive protein and erythrocyte sedimentation rate between the 2 groups. However, there was a significant difference in the rate of flair between the 2 groups since no flair in the early diagnosis group whereas 12 out of 25 patients (48.0%) in the delayed diagnosis group (p<0.001).

Conclusions Our present data suggest that early diagnosis is associated with the less flair in patients with RS3PE syndrome. Physicians are required to recognize this rare but important inflammatory condition found in elderly subjects.


  1. T. Origuchi, K. Arima, S.-Y. Kawashiri, M. Tamai, H. Nakamura, A. Kawakami, T. Tsukada, T. Miyashita, T. Aramaki, M. Furuyama, Y. Kawabe, N. Iwanaga, Y. Ueki, T. Fukuda, K. Eguchi: Surveillance of the Outcome of Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Syndrome. Ann Rheum Dis 2014;73:Suppl 2 105

Disclosure of Interest None declared

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