Remitting seronegative symmetrical synovitis with pitting edema (RS 3PE) syndrome in a tertiary care hospital: A retrospective analysis

Abstract

Remitting seronegative symmetrical synovitis with pitting edema (RS 3 PE) affects mainly elderly males, characterized by acute onset pitting edema of hands, negative rheumatoid factor and excellent result with short course of low dose corticosteroid therapy. To re-evaluate the clinical, laboratory features, management, and ultimate disease progression of RS 3 PE cases in rheumatology clinic in tertiary care hospital and compare results with previous literature. We selected the patients of RS 3 PE in the Rheumatology clinic, Medical College, Kolkata, between 1 January 2002 and 1 January 2010 and followed them up. Among the cases reviewed 23 were female patients and 12 were male patients with mean (SD) age of 54.74 (3.03) and 58.33 (5.33) years, respectively. Oral Hydroxychloroquine was started in all, giving a satisfactory result in 21 patients; rest of the 14 patients needed additional corticosteroid, to alleviate musculoskeletal symptoms. Baseline mean (SD) C-reactive protein and erythrocyte sedimentation rate were 21.63 (2.08) mg/L and 81.34 (9.29) mm/hr, respectively, and reduced to 3.23 (0.95) mg/L and 17.43 (5.55) mm/hr, respectively, following therapy. During follow-up, musculoskeletal symptoms relapsed in 17 patients, seven (20%) of them were found to be associated with malignancy. At the time of last visit during the follow-up period, only four patients developed definite arthropathy (one seronegative rheumatoid arthritis, three undifferentiated spondyloarthropathy), rest of the 31 cases were remitted. Regarding RS 3 PE, results of our study showed similarity with previous reports excepting the gender. Hydroxychloroquine has been proved as a good steroid-sparing agent in RS 3 PE. This study supported the association of RS 3 PE with malignancy in the previous literatures.