Images in Clinical Rheumatology
Remitting Symmetric Seronegative Synovitis With Pitting Edema (RS3PE)
Sinovitis simétrica seronegativa remitente con edema con fóvea (RS3PE)
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Upon physical examination a bland, painful edema of the lower limbs reaching the middle third, pitting hand edema and limitation for gripping, with important synovitis was seen (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis and Progression</span><p id="par0010" class="elsevierStylePara elsevierViewall">Treatment was started with diuretics and anti-inflammatory drugs, with reduction of the lower limb edema, but persisted with joint pain, synovitis and pitting hand edema.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Laboratory tests showed normocytic, normochromic anemia, with a 10.2<span class="elsevierStyleHsp" style=""></span>g/dl hemoglobin, an ESR of 55<span class="elsevierStyleHsp" style=""></span>mm/h, C reactive protein of 12.5<span class="elsevierStyleHsp" style=""></span>mg/dl; negative rheumatoid factor and ANA. Hand X-rays only showed an increase in soft tissue density and the chest X-ray was normal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Remitting seronegative symmetric synovitis with pitting edema (RS3PE) was diagnosed, starting treatment with prednisone 15<span class="elsevierStyleHsp" style=""></span>mg daily for 6 weeks and later reduction, being discharged after 3 days with evident improvement. After 6 months she came to the clinic showing important improvement and no hand edema or synovitis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">RS3PE is a symmetrical synovitis of rapid installation, with pitting edema on the back of the hands, no joint destruction and the absence of rheumatoid factor, predominantly found in men over 50.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a> It normally responds to steroid treatment. The term synovitis is used due to the symmetric polysynovitis of the joints and tendon sheaths of the fingers, associated to edema. Its etiology is unknown but Olivieri et al. suggest that the extensor tenosynovitis may be the origin of subcutaneous and peritendinous edema.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The syndrome is rare and often undiagnosed; signs and symptoms are frequently confused with other seronegative polyarthritis.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> It commonly has a benign course leading to remission but in some cases has been associated to neoplasia and hematologic alterations.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> In this case, what called for our attention was the fact that it was present in a woman under 50, but both the clinical picture and the response to treatment support the diagnosis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical Case" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis and Progression" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-02-21" "fechaAceptado" => "2011-05-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Serrano Ostoa B, Álvarez Hernández E. Sinovitis simétrica seronegativa remitente con edema con fóvea (RS3PE). Reumatol Clin. 2012;<span class="elsevierStyleBold">8</span>:156–7.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 335 "Ancho" => 900 "Tamanyo" => 62405 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pitting edema of the hands, synovitis and failure to grip.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 337 "Ancho" => 900 "Tamanyo" => 59097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Recovery 6 months after treatment with prednisone.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Remitting seronegative symmetrical synovitis with pitting edema: RS3PE syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.J. 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Sekhon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAAPA" "fecha" => "2010" "volumen" => "23" "paginaInicial" => "38" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20214247" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000000800000003/v1_201305061639/S2173574311000165/v1_201305061639/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000800000003/v1_201305061639/S2173574311000165/v1_201305061639/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574311000165?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 22 | 21 | 43 |
| 2024 October | 94 | 47 | 141 |
| 2024 September | 98 | 55 | 153 |
| 2024 August | 110 | 77 | 187 |
| 2024 July | 98 | 54 | 152 |
| 2024 June | 152 | 53 | 205 |
| 2024 May | 161 | 68 | 229 |
| 2024 April | 118 | 53 | 171 |
| 2024 March | 124 | 60 | 184 |
| 2024 February | 96 | 48 | 144 |
| 2024 January | 103 | 20 | 123 |
| 2023 December | 68 | 33 | 101 |
| 2023 November | 76 | 37 | 113 |
| 2023 October | 76 | 23 | 99 |
| 2023 September | 133 | 45 | 178 |
| 2023 August | 95 | 33 | 128 |
| 2023 July | 122 | 27 | 149 |
| 2023 June | 91 | 32 | 123 |
| 2023 May | 94 | 26 | 120 |
| 2023 April | 109 | 10 | 119 |
| 2023 March | 113 | 28 | 141 |
| 2023 February | 109 | 30 | 139 |
| 2023 January | 105 | 19 | 124 |
| 2022 December | 138 | 43 | 181 |
| 2022 November | 144 | 33 | 177 |
| 2022 October | 113 | 37 | 150 |
| 2022 September | 148 | 51 | 199 |
| 2022 August | 140 | 40 | 180 |
| 2022 July | 118 | 48 | 166 |
| 2022 June | 143 | 46 | 189 |
| 2022 May | 139 | 44 | 183 |
| 2022 April | 159 | 45 | 204 |
| 2022 March | 132 | 66 | 198 |
| 2022 February | 162 | 39 | 201 |
| 2022 January | 146 | 52 | 198 |
| 2021 December | 100 | 50 | 150 |
| 2021 November | 108 | 58 | 166 |
| 2021 October | 107 | 60 | 167 |
| 2021 September | 85 | 52 | 137 |
| 2021 August | 96 | 55 | 151 |
| 2021 July | 89 | 45 | 134 |
| 2021 June | 144 | 49 | 193 |
| 2021 May | 150 | 59 | 209 |
| 2021 April | 398 | 95 | 493 |
| 2021 March | 175 | 39 | 214 |
| 2021 February | 137 | 43 | 180 |
| 2021 January | 101 | 28 | 129 |
| 2020 December | 102 | 31 | 133 |
| 2020 November | 154 | 22 | 176 |
| 2020 October | 162 | 16 | 178 |
| 2020 September | 110 | 36 | 146 |
| 2020 August | 130 | 33 | 163 |
| 2020 July | 88 | 28 | 116 |
| 2020 June | 69 | 19 | 88 |
| 2020 May | 65 | 14 | 79 |
| 2020 April | 53 | 21 | 74 |
| 2020 March | 29 | 5 | 34 |
| 2020 February | 1 | 0 | 1 |
| 2020 January | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 June | 1 | 0 | 1 |
| 2019 March | 1 | 0 | 1 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 11 | 0 | 11 |
| 2018 April | 105 | 10 | 115 |
| 2018 March | 138 | 10 | 148 |
| 2018 February | 79 | 7 | 86 |
| 2018 January | 72 | 4 | 76 |
| 2017 December | 69 | 9 | 78 |
| 2017 November | 78 | 13 | 91 |
| 2017 October | 85 | 8 | 93 |
| 2017 September | 82 | 13 | 95 |
| 2017 August | 87 | 22 | 109 |
| 2017 July | 93 | 16 | 109 |
| 2017 June | 89 | 15 | 104 |
| 2017 May | 119 | 17 | 136 |
| 2017 April | 86 | 15 | 101 |
| 2017 March | 141 | 13 | 154 |
| 2017 February | 152 | 21 | 173 |
| 2017 January | 104 | 10 | 114 |
| 2016 December | 174 | 27 | 201 |
| 2016 November | 188 | 7 | 195 |
| 2016 October | 174 | 20 | 194 |
| 2016 September | 299 | 12 | 311 |
| 2016 August | 276 | 11 | 287 |
| 2016 July | 109 | 16 | 125 |
| 2016 April | 1 | 0 | 1 |
| 2016 March | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 2 | 0 | 2 |
| 2015 July | 101 | 6 | 107 |
| 2015 June | 169 | 15 | 184 |
| 2015 May | 157 | 19 | 176 |
| 2015 April | 150 | 23 | 173 |
| 2015 March | 138 | 13 | 151 |
| 2015 February | 115 | 10 | 125 |
| 2015 January | 113 | 28 | 141 |
| 2014 December | 121 | 24 | 145 |
| 2014 November | 108 | 24 | 132 |
| 2014 October | 120 | 22 | 142 |
| 2014 September | 92 | 24 | 116 |
| 2014 August | 111 | 24 | 135 |
| 2014 July | 116 | 25 | 141 |
| 2014 June | 125 | 36 | 161 |
| 2014 May | 123 | 31 | 154 |
| 2014 April | 151 | 32 | 183 |
| 2014 March | 438 | 31 | 469 |
| 2014 February | 605 | 20 | 625 |
| 2014 January | 96 | 23 | 119 |
| 2013 December | 70 | 17 | 87 |
| 2013 November | 92 | 35 | 127 |
| 2013 October | 105 | 24 | 129 |
| 2013 September | 91 | 21 | 112 |
| 2013 August | 94 | 35 | 129 |
| 2013 July | 103 | 28 | 131 |
| 2013 June | 85 | 34 | 119 |
| 2013 May | 93 | 64 | 157 |
| 2013 April | 77 | 44 | 121 |
| 2013 March | 77 | 39 | 116 |
| 2013 February | 75 | 32 | 107 |
| 2013 January | 96 | 27 | 123 |
| 2012 December | 55 | 16 | 71 |
| 2012 November | 72 | 41 | 113 |
| 2012 October | 33 | 40 | 73 |
| 2012 September | 13 | 3 | 16 |
| 2012 July | 2 | 0 | 2 |
| 2012 June | 8 | 0 | 8 |
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