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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a case of RS3PE syndrome with positive rheumatoid factor &#40;RF&#41; that commenced as positive following the development of a tumour&#46; This normally occurs in these cases years before the appearance of the same&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">RS3PE syndrome was described by McCarty in 1985&#46; It occurs predominantly in men over the age of 60 years old &#40;2&#47;3&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and it has a higher incidence in the white race and rural population&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It may be primary or secondary&#44; associated with infections&#44; systemic diseases&#44; Sj&#246;gren&#39;s syndrome<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> or rheumatoid arthritis &#40;RA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> It may be associated with digestive neoplasias&#44; with very few described cases of colon adenocarcinoma&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> haematological&#44; gynaecological and nephrological neoplasias&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> or drugs&#44; such as type IDPP-4 antidiabetic drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It has a rapid onset&#44; almost always in less than one month&#46; It is characterised by symmetrical polyarthritis with synovitis of the extensor and flexor tendons&#44; severe oedema with a depression in the back of the hands and weakness of the pelvic and scapular waists&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The criteria proposed by Olivo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> are used for diagnosis&#44; and in complementary tests RF is usually negative&#44; although in the medical literature a very few cases are described with positive RF&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> as well as with positive anti-CCP&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Prednisone is used in 95&#37; of cases&#44; of which 74&#37; receive doses of from 15 to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;day during treatment lasting for from 3 to 6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Our case is that of a 72 year-old man&#44; Caucasian and living in a rural environment&#46; He visited on several occasions due to oedema with a depression on the hands&#44; fundamentally&#44; and to a lesser degree on the ankles&#59; pain and functional weakness in the scapular waist&#44; morning rigidity&#44; symmetrical polyarthritis of the upper limbs and difficulty in flexing-extending both hands&#46; He had no fever&#44; constitutional syndrome or clinical signs of arthritis&#59; no aphtha or uveitis&#46; He underwent treatment with a NSAID and diuretics for this reason&#44; without showing any improvement&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The following aspects of his clinical history stood out&#58; AHT&#44; long-term DM2&#44; dyslipidemia&#44; arrhythmia due to auricular fibrillation&#44; no rheumatological history and total colectomy with ileo-rectal anastomosis due to colon adenocarcinoma&#46; He was in follow-up with no signs of relapse&#44; and habitually took antihypertensive and antihyperlipidemic agents&#44; as well as digoxin and oral antidiabetics &#40;including IDPP-4 for several years&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The analytical findings were&#58; 9&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl haemoglobin&#44; positive RF&#44; 20<span class="elsevierStyleHsp" style=""></span>UI&#47;ml and raised ESR&#44; 49<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#46; ANA&#44; ANCA&#44; anti-CCP&#44; tumour markers&#44; proteinogram and PCR determination showed no pathological results&#46; A colonoscopy was performed which showed anastomosis without alterations&#44; and oral endoscopy was normal&#46; Hand X-rays showed no signs of erosive lesions and abdominal CT showed no signs of relapse or metastasis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment commenced with calcium&#44; vitamin D and 20<span class="elsevierStyleHsp" style=""></span>mg prednisone per day&#44; giving rise to a notable improvement after a few days&#46; The corticoid dose was reduced in successive check-ups&#44; and the patient currently takes 5<span class="elsevierStyleHsp" style=""></span>mg prednisone per day&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our case&#44; given the clinical characteristics described as well as the swift response to treatment with prednisone&#44; although it has the peculiarity of positive RF&#44; we are able to state that it is an RS3PE syndrome as it fulfils 6 of the 7 diagnostic criteria proposed by Olivo et al&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">As this is a new entity that has hardly been described&#44; with an unknown incidence and diagnostic criteria that are fundamentally clinical&#44; 6 out of 7 of the same&#44; with the exception of the RF determination&#44; which is typically negative&#44; we believe that this fact should strengthen the diagnosis&#44; given that it is included in its definition&#44; so that its positivity should not exclude it or rule it out&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Unlike other authors&#44; who believe RS3PE syndrome to be a benign form of seronegative rheumatoid arthritis in the elderly&#44; we see it initially as a different entity from other rheumatological processes which appears in the elderly in the majority of cases&#44; although it may commence at early ages&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The chief characteristic&#44; which is present in 100&#37; of cases&#44; is oedema on the back of the hands&#46; It may be associated with other diseases or evolve into a specific rheumatoid condition&#46; Although it normally progresses with negative RF&#44; this may sometimes be positive&#44; as it is in our case&#46; Thus something similar would occur with RA&#58; a positive result of RF would not reveal the diagnosis of the same&#44; given that approximately 20&#37; of the individuals with RA do not have detectable values of RF&#59; moreover&#44; other diseases may arise with a positive RF result&#44; including in individuals&#44; above all the elderly and the healthy&#44; so that it has no clinical repercussion in them &#40;up to 5&#37; of the healthy population&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We also believe that&#44; although at the moment it was diagnosed the syndrome gave rise to no alarming signs and&#47;or symptoms&#44; the existence of a tumour has to be ruled out&#44; and the patient has to be monitored&#58; they may eventually develop a rheumatological disease &#40;more so if at the moment of diagnosis alterations are found in an analytical or radiological test&#41; or a tumour may develop over years&#44; or it may be an essential form of the condition with an excellent prognosis&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">More specifically&#44; as our patient had had a tumour &#40;altered immunity status&#41; this may justify alteration in the RF&#44; but nor is it possible to rule out that over time a rheumatic polymialgia or rheumatoid arthritis may develop&#44; although this is rare&#44; or a relapse of the tumour may occur&#46; It is for this reason that we are monitoring the patient&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Finally&#44; in those cases which are not seronegative &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; if the suspicion exists that there is another entity&#44; and if this is confirmed by laboratory tests or clinically then it should be treated and the response should be monitored&#46; In those cases where this question is not fully clear low-dose corticoid treatment should be commenced&#44; and if the response is favourable after a few days then the case consists of an RS3PE syndrome&#46; Another option that would guide diagnosis would be IL-6 determination&#59; nevertheless&#44; to differentiate RA from the RS3PE syndrome it would be more useful to determine VEGF and MMP-3&#44; as if they are raised this would favour the later diagnosis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Symptom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oedema on back of hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oedema with a depression on back of hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oedema on back of hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Analytical tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RF&#58; &#43;&#59; anti-CCP&#58; &#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RF&#58; &#8722;&#59; anti-CCP&#58; &#43;&#59; MMP-3&#58; &#43;&#59; VEGF&#58; &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RF&#58; &#43;&#59; ANA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;anti-Ro and anti-RNP&#58; &#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ultrasound scan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extensor tenosynovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extensor tenosynovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suspicion of&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RAMDCTSj&#246;gren&#39;s syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Confirmed by&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Response to low-dose corticoidsNo signs of erosion in the X-rayUltrasound scan findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Response to low-dose corticoidsNo signs of erosion in the X-rayUltrasound scan findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Response to low-dose corticoidsNo signs of erosion in the X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ruled out due to&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lack of response to FAME 6&#8211;12 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not ruled out&#44; although anti-CCP&#43; is present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RA&#58; no diagnostic criteria for RAMDCT&#58; no myositis or Raynaud phenomenon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Final diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RS3PE syndrome with RF&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RA complicated by symptoms of RS3PE syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RS3PE syndrome in a patient with Sj&#246;gren&#39;s syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coincidences of RS3PE Cases That Are not Seronegative&#46;</p>"
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      ]
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Letter to the Editor
RS3PE Syndrome With Positive Rheumatoid Factor
Síndrome RS3PE con factor reumatoide positivo
Fernando Moreno Obregóna,
Corresponding author
fmorenobregon@hotmail.com

Corresponding author.
, Matilde del Castillo Madrigalb, Fernando Díaz Narváezb, Francisco Javier Pérez Delgadoa
a Urgencias, Hospital Infanta Elena, Huelva, Spain
b Medicina Interna, Hospital Infanta Elena, Huelva, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a case of RS3PE syndrome with positive rheumatoid factor &#40;RF&#41; that commenced as positive following the development of a tumour&#46; This normally occurs in these cases years before the appearance of the same&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">RS3PE syndrome was described by McCarty in 1985&#46; It occurs predominantly in men over the age of 60 years old &#40;2&#47;3&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and it has a higher incidence in the white race and rural population&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It may be primary or secondary&#44; associated with infections&#44; systemic diseases&#44; Sj&#246;gren&#39;s syndrome<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> or rheumatoid arthritis &#40;RA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> It may be associated with digestive neoplasias&#44; with very few described cases of colon adenocarcinoma&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> haematological&#44; gynaecological and nephrological neoplasias&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> or drugs&#44; such as type IDPP-4 antidiabetic drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It has a rapid onset&#44; almost always in less than one month&#46; It is characterised by symmetrical polyarthritis with synovitis of the extensor and flexor tendons&#44; severe oedema with a depression in the back of the hands and weakness of the pelvic and scapular waists&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The criteria proposed by Olivo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> are used for diagnosis&#44; and in complementary tests RF is usually negative&#44; although in the medical literature a very few cases are described with positive RF&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> as well as with positive anti-CCP&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Prednisone is used in 95&#37; of cases&#44; of which 74&#37; receive doses of from 15 to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;day during treatment lasting for from 3 to 6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Our case is that of a 72 year-old man&#44; Caucasian and living in a rural environment&#46; He visited on several occasions due to oedema with a depression on the hands&#44; fundamentally&#44; and to a lesser degree on the ankles&#59; pain and functional weakness in the scapular waist&#44; morning rigidity&#44; symmetrical polyarthritis of the upper limbs and difficulty in flexing-extending both hands&#46; He had no fever&#44; constitutional syndrome or clinical signs of arthritis&#59; no aphtha or uveitis&#46; He underwent treatment with a NSAID and diuretics for this reason&#44; without showing any improvement&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The following aspects of his clinical history stood out&#58; AHT&#44; long-term DM2&#44; dyslipidemia&#44; arrhythmia due to auricular fibrillation&#44; no rheumatological history and total colectomy with ileo-rectal anastomosis due to colon adenocarcinoma&#46; He was in follow-up with no signs of relapse&#44; and habitually took antihypertensive and antihyperlipidemic agents&#44; as well as digoxin and oral antidiabetics &#40;including IDPP-4 for several years&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The analytical findings were&#58; 9&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl haemoglobin&#44; positive RF&#44; 20<span class="elsevierStyleHsp" style=""></span>UI&#47;ml and raised ESR&#44; 49<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#46; ANA&#44; ANCA&#44; anti-CCP&#44; tumour markers&#44; proteinogram and PCR determination showed no pathological results&#46; A colonoscopy was performed which showed anastomosis without alterations&#44; and oral endoscopy was normal&#46; Hand X-rays showed no signs of erosive lesions and abdominal CT showed no signs of relapse or metastasis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment commenced with calcium&#44; vitamin D and 20<span class="elsevierStyleHsp" style=""></span>mg prednisone per day&#44; giving rise to a notable improvement after a few days&#46; The corticoid dose was reduced in successive check-ups&#44; and the patient currently takes 5<span class="elsevierStyleHsp" style=""></span>mg prednisone per day&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our case&#44; given the clinical characteristics described as well as the swift response to treatment with prednisone&#44; although it has the peculiarity of positive RF&#44; we are able to state that it is an RS3PE syndrome as it fulfils 6 of the 7 diagnostic criteria proposed by Olivo et al&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">As this is a new entity that has hardly been described&#44; with an unknown incidence and diagnostic criteria that are fundamentally clinical&#44; 6 out of 7 of the same&#44; with the exception of the RF determination&#44; which is typically negative&#44; we believe that this fact should strengthen the diagnosis&#44; given that it is included in its definition&#44; so that its positivity should not exclude it or rule it out&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Unlike other authors&#44; who believe RS3PE syndrome to be a benign form of seronegative rheumatoid arthritis in the elderly&#44; we see it initially as a different entity from other rheumatological processes which appears in the elderly in the majority of cases&#44; although it may commence at early ages&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The chief characteristic&#44; which is present in 100&#37; of cases&#44; is oedema on the back of the hands&#46; It may be associated with other diseases or evolve into a specific rheumatoid condition&#46; Although it normally progresses with negative RF&#44; this may sometimes be positive&#44; as it is in our case&#46; Thus something similar would occur with RA&#58; a positive result of RF would not reveal the diagnosis of the same&#44; given that approximately 20&#37; of the individuals with RA do not have detectable values of RF&#59; moreover&#44; other diseases may arise with a positive RF result&#44; including in individuals&#44; above all the elderly and the healthy&#44; so that it has no clinical repercussion in them &#40;up to 5&#37; of the healthy population&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We also believe that&#44; although at the moment it was diagnosed the syndrome gave rise to no alarming signs and&#47;or symptoms&#44; the existence of a tumour has to be ruled out&#44; and the patient has to be monitored&#58; they may eventually develop a rheumatological disease &#40;more so if at the moment of diagnosis alterations are found in an analytical or radiological test&#41; or a tumour may develop over years&#44; or it may be an essential form of the condition with an excellent prognosis&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">More specifically&#44; as our patient had had a tumour &#40;altered immunity status&#41; this may justify alteration in the RF&#44; but nor is it possible to rule out that over time a rheumatic polymialgia or rheumatoid arthritis may develop&#44; although this is rare&#44; or a relapse of the tumour may occur&#46; It is for this reason that we are monitoring the patient&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Finally&#44; in those cases which are not seronegative &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; if the suspicion exists that there is another entity&#44; and if this is confirmed by laboratory tests or clinically then it should be treated and the response should be monitored&#46; In those cases where this question is not fully clear low-dose corticoid treatment should be commenced&#44; and if the response is favourable after a few days then the case consists of an RS3PE syndrome&#46; Another option that would guide diagnosis would be IL-6 determination&#59; nevertheless&#44; to differentiate RA from the RS3PE syndrome it would be more useful to determine VEGF and MMP-3&#44; as if they are raised this would favour the later diagnosis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span>"
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Symptom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oedema on back of hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oedema with a depression on back of hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oedema on back of hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Analytical tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RF&#58; &#43;&#59; anti-CCP&#58; &#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RF&#58; &#8722;&#59; anti-CCP&#58; &#43;&#59; MMP-3&#58; &#43;&#59; VEGF&#58; &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RF&#58; &#43;&#59; ANA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;anti-Ro and anti-RNP&#58; &#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ultrasound scan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extensor tenosynovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extensor tenosynovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suspicion of&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RAMDCTSj&#246;gren&#39;s syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Confirmed by&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Response to low-dose corticoidsNo signs of erosion in the X-rayUltrasound scan findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Response to low-dose corticoidsNo signs of erosion in the X-rayUltrasound scan findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Response to low-dose corticoidsNo signs of erosion in the X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ruled out due to&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lack of response to FAME 6&#8211;12 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not ruled out&#44; although anti-CCP&#43; is present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RA&#58; no diagnostic criteria for RAMDCT&#58; no myositis or Raynaud phenomenon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Final diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RS3PE syndrome with RF&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RA complicated by symptoms of RS3PE syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RS3PE syndrome in a patient with Sj&#246;gren&#39;s syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2169559.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coincidences of RS3PE Cases That Are not Seronegative&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                0 => array:2 [
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                      ]
                    ]
                  ]
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              ]
            ]
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                0 => array:2 [
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                          "etal" => false
                          "autores" => array:3 [
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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            ]
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                        ]
                      ]
                    ]
                  ]
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            ]
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                          "etal" => true
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                            0 => "D&#46; Olivo"
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                  ]
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                        0 => array:2 [
                          "etal" => false
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                  ]
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                    0 => array:1 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;G&#46; Gurbuz"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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Article information
ISSN: 21735743
Original language: English
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Idiomas
Reumatología Clínica (English Edition)
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