RS3PE
Is Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) a Subset of Rheumatoid Arthritis?

https://doi.org/10.1016/j.semarthrit.2008.11.006Get rights and content

Objectives

To contrast and compare the spectrum of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) with rheumatoid arthritis (RA) using an illustrative case.

Methods

The relevant English literature of RS3PE was searched using the keywords “RS3PE” alone and in combination with terms such as neoplasia and rheumatic disease. Original and review articles were reviewed and the clinical setting was exemplified with a case report.

Results

RS3PE initially was reported to represent a form of RA. However, RS3PE has clinical features that are different from both early- and late-onset RA, such as lack of bony erosions and rheumatoid factor. RS3PE is thought to involve vascular endothelial growth factor, suggesting an infectious etiology, generally has an excellent prognosis, and is associated with neoplasia not commonly seen in RA, and the RA associated human leukocyte antigen (HLA) DRB1 genotype is absent.

Conclusions

Based on the clinical, laboratory, suspected infectious etiology, genetic differences, and types of associated malignancies, RS3PE appears to be a distinct entity rather than a subset of RA.

Section snippets

Methods

A PubMed and OVID database search of the English language literature between January 1985 and July 2008 was performed using the keyword RS3PE in combination with neoplasia, rheumatic diseases, etiology, elderly-onset RA, or pathogenesis. All relevant English language articles were reviewed and references screened for additional articles. The review is supplemented with the report of a patient with RS3PE.

Case Report

A 70-year-old woman presented to the Rheumatology Clinic in the University of California at Los Angeles, California Medical Center with rapid-onset painful and swollen hands, ankles, and feet of 2 months' duration and a painful right shoulder. Morning stiffness was most severe and lasted all day. She complained of fatigue without fever, rash, or weight loss. Malignancy workup was negative including computed tomography of the thorax, abdomen, and pelvis, and colonoscopy because she had an

Discussion

RS3PE is a distinct syndrome/entity rather than a subset of RA. RS3PE always has pitting edema, negative RF, absence of bony erosions, generally has an excellent therapeutic response to a small dose of glucocorticoid, and lacks the HLADRB1 genotype that is present in both early- and late-onset RA. More importantly, RS3PE appears to be associated with a significantly higher rate of neoplasia than RA and to have a different neoplastic pattern. Serum VEGF levels are substantially higher than in

Acknowledgment

The authors are thankful to Dr. John Fitzgerald for constructive comments during manuscript preparation.

References (52)

  • T. Oide et al.

    Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in Nagano, Japan: clinical, radiological, and cytokine studies of 13 patients

    Clin Exp Rheumatol

    (2004)
  • T. Schaeverbeke et al.

    Remitting seronegative symmetrical synovitis with pitting oedema: disease or syndrome?

    Ann Rheum Dis

    (1995)
  • A. Olivé et al.

    The clinical spectrum of remitting seronegative symmetrical synovitis with pitting edemaThe Catalán Group for the Study of RS3PE

    J Rheumatol

    (1997)
  • Toussirot E, Berthier S, Wendling D, Tiberghien P. Lack of association between HLA DRB1* alleles and RS3PE syndrome....
  • A. Klauser et al.

    Remitting seronegative symmetrical synovitis with pitting edema of the hands: ultrasound, color Doppler ultrasound, and magnetic resonance imaging findings

    Arthritis Rheum

    (2005)
  • S. Paira et al.

    Remitting seronegative symmetrical synovitis with pitting oedema: a study of 12 cases

    Clin Rheumatol

    (2002)
  • R. Queiro

    RS3PE syndrome: a clinical and immunogenetical study

    Rheumatol Int

    (2004)
  • M. Gumá et al.

    RS3PE: six years later

    Ann Rheum Dis

    (1999)
  • J.P. Hellier et al.

    HLA-DRB1 genes and patients with late onset rheumatoid arthritis

    Ann Rheum Dis

    (2001)
  • E.B. Russell

    Remitting seronegative symmetrical synovitis with pitting edema syndrome: followup for neoplasia

    J Rheumatol

    (2005)
  • S.E. Tunc et al.

    Paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome): a report of two cases and review of the literature

    Rheumatol Int

    (2004)
  • M. Vinci et al.

    RS3PE and ovarian cancer

    Ann Rheum Dis

    (2001)
  • F. Cantini et al.

    Paraneoplastic remitting seronegative symmetrical synovitis with pitting edema

    Clin Exp Rheumatol

    (1999)
  • J. Sibilia et al.

    Remitting seronegative symmetrical synovitis with pitting edema (RS3PE): a form of paraneoplastic polyarthritis?

    J Rheumatol

    (1999)
  • A. Ethiopia et al.

    Gastric carcinoma in association with remitting seronegative symmetrical synovitis with pitting edema

    J Rheumatol

    (1999)
  • Y. Tada et al.

    Remitting seronegative symmetrical synovitis with pitting edema associated with gastric carcinoma

    J Rheumatol

    (1997)
  • Cited by (0)

    The authors have no conflicts of interest to disclose.

    View full text