Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) syndrome in an elderly Spanish patient: Ruling-out polymyalgia rheumatica and management

Abstract

BackgroundThe Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) syndrome is a rare rheumatological disorder of the elderly with pitting edema and tenosynovitis of the hands as notable features. Aim of the workThis case report presents an elderly male patient with RS3PE without arthritis after ruling out polymylagia rheumatica (PMR) or any associated malignancy. Case presentationA 73-year-old white man presented to the Hospital of Navarra, Spain with pain and weakness in both upper extremities, predominantly in wrists, associated with symmetrical swelling of dorsum of both hands of two months duration. The patient was febrile (37.5 °C) had pitting edema in both hands, with no signs of arthritis, associated with shoulder girdle muscles weakness without pelvic involvement. The lower limbs and feet were not involved. The differential diagnosis of PMR was raised adding to the clinical diagnostic dilemma. Erythrocyte sedimentation rate was 66 mm/1st hour and C-reactive protein 126.4 mg/L. Extended diagnostic work showed negative autoimmune biomarkers with normal complement. No joint erosion was found on plain x-ray radiography of the affected joints. Thoracic and abdominal CT scan was performed with no evidence of a neoplastic disease. The patient was finally diagnosed with RS3PE showing a rapid response to low doses of prednisone (20 mg/day) and without any further flares on follow up. ConclusionRS3PE could be diagnosed even without polyarthritis and successfully treated by low dose steroids after excluding any related malignancy. Excluding PMR is important to avoid exposing the patient to unwanted higher steroid doses.