1
|
Matsubara T, Uda C, Sano C, Ohta R. A Case Report of Remitting Seronegative Symmetrical Synovitis With Pitting Edema Causing Severe Anemia, Acute Progressive Dementia, and Chronic Eczema in an Older Female. Cureus 2024; 16:e58940. [PMID: 38800308 PMCID: PMC11125455 DOI: 10.7759/cureus.58940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a type of seronegative arthritis characterized by a favorable prognosis (Remitting), absence of rheumatoid factor (Seronegative), symmetry (Symmetrical), and synovitis with pitting edema on the backs of the hands and feet. The cause of RS3PE syndrome remains unknown, but involvement of the immune system is suspected, and steroids are highly effective. Here, we present a case of an 86-year-old woman with severe anemia and bilateral lower limb edema accompanied by chronic eczema, considered to be caused by RS3PE syndrome. The patient's symptoms included bilateral lower limb edema, allergic rash, cognitive decline, and difficulty in moving, all of which were attributed to RS3PE syndrome. Given the variety of systemic symptoms associated with RS3PE syndrome, which can significantly impair the activities of daily living (ADLs) in the elderly, early detection and treatment are crucial.
Collapse
Affiliation(s)
| | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
| | | |
Collapse
|
2
|
Ohmura H, Kondo M, Uenomachi M, Ariyama H, Ito M, Tsuchihashi K, Ayano M, Niiro H, Akashi K, Baba E. Case Report: Resolution of remitting seronegative symmetrical synovitis with pitting edema during nivolumab therapy for gastric cancer. Front Oncol 2023; 13:1260818. [PMID: 37869081 PMCID: PMC10586790 DOI: 10.3389/fonc.2023.1260818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
The anti-programmed cell death-1 (PD-1) antibody nivolumab has been shown to significantly prolong the survival of patients with unresectable advanced or recurrent gastric cancer (AGC). However, immune-related adverse events (irAEs), which show different profiles from those of cytotoxic agents or conventional molecular-targeted drugs including tyrosine kinase inhibitors, have been reported. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare autoimmune disorder with acute-onset, rheumatoid factor-negative, symmetric synovitis associated with limb edema observed in elderly persons. A case of RS3PE syndrome that developed after administration of nivolumab for advanced gastric cancer is reported. This is the first report of a case of RS3PE syndrome as an irAE caused by nivolumab in a patient with gastric cancer.
Collapse
Affiliation(s)
- Hirofumi Ohmura
- Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Moe Kondo
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Masato Uenomachi
- Department of Diabetes Mellitus and Endocrinology, Nanpuh Hospital, Kagoshima, Japan
| | - Hiroshi Ariyama
- Department of Oncology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Mamoru Ito
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kenji Tsuchihashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Masahiro Ayano
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiroaki Niiro
- Department of Medical Education, Kyushu University Faculty of Medical Sciences, Fukuoka, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| |
Collapse
|
3
|
Pimentel-León RR, García-Chávez M, Chávez-Sánchez IN. [Remitting seronegative symetrical synovitis with pitting edema. One case report]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:363-369. [PMID: 37216683 PMCID: PMC10437230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/06/2022] [Indexed: 05/24/2023]
Abstract
Background RS3PE (remitting seronegative symmetrical synovitis with edema and pitting) is a rare entity of unknown etiology that has been related to genetic predisposition due to the presence of HLA-A2 in 50% of cases and less frequently HLA-B7. Its pathogenesis is unknown, but it has been related to growth factors, and some mediators (TNF, IL-6). It is common in elderly people and the course of this illness presents with acute symmetrical polyarthritis, accompanied by edema in hands and feet. The diagnosis requires a high index of suspicion and to differentiate it from other entities such as rheumatoid arthritis, complex regional pain syndrome, rheumatic polymyalgia, in addition to ruling out malignant neoplasms, since there are many reports of its association with both solid and hematological neoplasms, being of bad prognosis when there is association. When there is no association with cancer, it responds well to the use of low doses of steroids and its prognosis is usually favorable. Clinical case 80-year-old woman with an acute onset with polyarthralgia, functional limitation associated with pitting edema in hands and feet. After approaching the patient and ruling out associated neoplasms, it was diagnosed RS3PE. It was managed with prednisone, observing a good response, with remission of the manifestations at 6 weeks and subsequent suspension of the steroid. Conclusions RS3PE is a rare entity, and a high index of suspicion is required for the diagnosis. A complete approach is important to rule out cancer in patients affected with this syndrome. Prednisone continues to be the best therapeutic option.
Collapse
Affiliation(s)
- Rafael Rubén Pimentel-León
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 1, Servicio de Reumatología. La Loma, Tlaxcala, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Margarita García-Chávez
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional Ignacio Zaragoza, Servicio de Inmunología y Alergia. Ciudad de México, MéxicoInstituto de Seguridad y Servicios Sociales de los Trabajadores del EstadoMéxico
| | - Iliana Nelly Chávez-Sánchez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| |
Collapse
|
4
|
Paraneoplastic musculoskeletal disorders: review and update for radiologists. Skeletal Radiol 2023; 52:421-433. [PMID: 35604445 DOI: 10.1007/s00256-022-04074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
Rheumatic paraneoplastic syndromes are rare syndromes that occur at distant sites from the underlying tumor and may involve the bones, joints, fasciae, muscles, or vessels. In the absence of a known tumor, early recognition of a rheumatic syndrome as paraneoplastic permits dedicated work-up for, and potentially early treatment of an occult malignancy. Although there is a continuously growing list of paraneoplastic rheumatic disorders, not all of these disorders have a well-established association with a neoplastic process. The goals of this article are to review the clinical characteristics, diagnostic work-up, and imaging findings of well-documented rheumatic paraneoplastic disorders.
Collapse
|
5
|
Janse van Rensburg HJ, Spiliopoulou P, Makhzoum A, Healy BD. Remitting Seronegative Symmetrical Synovitis with Pitting Edema: A Case Report of an Immune-Related Adverse Event following Surgery. Case Rep Oncol 2023; 16:662-669. [PMID: 37933314 PMCID: PMC10625819 DOI: 10.1159/000532004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/29/2023] [Indexed: 11/08/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have emerged as a novel class of anti-neoplastic agent in oncology. Their integration into practice has been accompanied by "immune-related adverse events" (irAEs) wherein off-target immune responses damage healthy tissues. Severe irAEs can cause irreversible organ dysfunction and death. Despite this, little is known about factors which predispose certain patients to develop irAEs or which precipitate their onset. Here, we report a case of a patient with melanoma who completed adjuvant immunotherapy, underwent elective hip replacement, and developed a rare rheumatologic irAE (remitting seronegative symmetrical synovitis with pitting edema) post-operatively. Mechanistically, we hypothesize that surgery contributed to irAE pathogenesis as a sensitizing event in which self-antigens were presented to an immune system with diminished peripheral tolerance in the context of recent ICI administration. This case highlights a need for future correlative analyses, investigating whether iatrogenic interventions such as surgery might be associated with irAE development.
Collapse
Affiliation(s)
| | - Pavlina Spiliopoulou
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Anas Makhzoum
- Department of Rheumatology, Trillium Health Partners, Mississauga, ON, Canada
| | - Brian D. Healy
- Department of Oncology, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| |
Collapse
|
6
|
Arino H, Muramae N, Okano M, Mori K, Otsui K, Sakaguchi K. Acute Onset of Remitting Seronegative Symmetrical Synovitis With Pitting Edema (RS3PE) Two Weeks After COVID-19 Vaccination With mRNA-1273 With Possible Activation of Parvovirus B19: A Case Report With Literature Review. Cureus 2022; 14:e24952. [PMID: 35706724 PMCID: PMC9187273 DOI: 10.7759/cureus.24952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare clinical entity characterized by “remitting,” “seronegative,” and “symmetrical” synovitis with pitting edema on the dorsum of the hands and feet. Although rheumatic or malignant diseases are diseases that are known to coexist with RS3PE, other factors such as medication, infection, and vaccination have been reported to be associated with RS3PE. Here, we present a case of RS3PE syndrome that satisfied all four diagnostic criteria of RS3PE (pitting edema in the limbs, acute onset, age ≥ 50 years, and/or rheumatoid factor negativity) after mRNA-1273 SARS-CoV-2 vaccination.
Collapse
|
7
|
Nagatomo Y, Ono M, Kinoshita H, Takeda Y, Nakamura H, Aoshiba K. Bilateral pleural effusion associated with remitting seronegative symmetrical synovitis with pitting edema syndrome. Oxf Med Case Reports 2022; 2022:omac003. [PMID: 35198226 PMCID: PMC8858391 DOI: 10.1093/omcr/omac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/14/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yoko Nagatomo
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
- Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Mariko Ono
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
- Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Hayato Kinoshita
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
- Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yukihisa Takeda
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
| | - Hiroyuki Nakamura
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
| |
Collapse
|
8
|
Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Syndrome: A Single-Center Experience. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.964824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
9
|
Gan Y, Sun Y, Jin J, Wang Y, Chen J, Chung Y, Li X, Ye H. bFGF could be a biomarker of malignancy in RS 3PE syndrome: an ambispective single-center cohort analysis of 51 patients. Arthritis Res Ther 2021; 23:261. [PMID: 34654466 PMCID: PMC8518293 DOI: 10.1186/s13075-021-02638-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare inflammatory arthritis, with a higher incidence of malignancy. The aim of this study is to identify biomarkers for predicting malignancy in RS3PE. Methods A total of 51 patients with RS3PE from September 2007 to May 2019 were retrospectively reviewed and followed for up to 5 years, with 15 patients with osteoarthritis (OA) and 14 patients with elderly-onset rheumatoid arthritis (EORA) as disease controls. Serum levels of angiogenesis cytokines were measured by electrochemiluminescent immunoassay and Luminex Human Magnetic Assay. Clinical data and laboratory parameters were analyzed to identify risk factors for malignancy. Results A total of forty-eight RS3PE patients (94.1%) were available with follow-up data; 8 patients (16.7%) were diagnosed with malignancy, of which 6 patients were hematological tumor; and 2 patients were solid tumors. Serum levels of basic fibroblast growth factor (bFGF) were exclusively higher in RS3PE patients with malignancy [14.21 (7.52, 23.18) ng/mL] than RS3PE patients without malignancy [4.32 (2.88, 7.42) ng/mL], OA [3.20 (2.20, 5.30) ng/mL], and EORA [3.20 (2.20, 5.30) ng/mL]. The optimal cut-off value of bFGF for malignancy was 10ng/mL in RS3PE. Logistic regression analysis indicated that elevation of bFGF was a risk factor for malignancy in RS3PE. Conclusions This study indicated that bFGF was elevated in RS3PE patients with malignancy and could serve as a biomarker for predicting paraneoplastic RS3PE.
Collapse
Affiliation(s)
- Yuzhou Gan
- Department of Rheumatology & Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.,Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Yi Sun
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China
| | - Jiayang Jin
- Department of Rheumatology & Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.,Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Yifan Wang
- Department of Rheumatology & Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.,Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Jiali Chen
- Department of Rheumatology & Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.,Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Yukchiu Chung
- Department of Rheumatology & Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.,Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Xue Li
- Department of Rheumatology & Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.,Center of Clinical Immunology, Peking University, Beijing, 100044, China
| | - Hua Ye
- Department of Rheumatology & Immunology and Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China. .,Center of Clinical Immunology, Peking University, Beijing, 100044, China.
| |
Collapse
|
10
|
Horai Y, Shimizu T, Okada A, Tokumitsu J, Ikeoka T, Kuriya G, Iwanaga N, Izumi Y, Origuchi T, Kawakami A. Dipeptidyl peptidase-4 inhibitor use is associated with a lower erythrocyte sedimentation rate in patients with remitting seronegative symmetrical synovitis with pitting oedema and pre-existing diabetes mellitus. Mod Rheumatol 2021; 32:830-833. [PMID: 34908128 DOI: 10.1093/mr/roab036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/03/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Akitomo Okada
- Department of Rheumatology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Junichi Tokumitsu
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Toshiyuki Ikeoka
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Genpei Kuriya
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan.,Diabetes Center, Sasebo Chuo Hospital, Nagasaki, Sasebo, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Tomoki Origuchi
- Unit of Translational Medicine, Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
11
|
Rösler A, Humbla O. [Unusual edema]. Z Gerontol Geriatr 2021; 54:444-445. [PMID: 33914113 DOI: 10.1007/s00391-021-01901-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Alexander Rösler
- Agaplesion Bethesda Krankenhaus Hamburg Bergedorf, Glindersweg 80, 21029, Hamburg, Deutschland.
| | - Olaf Humbla
- Agaplesion Bethesda Krankenhaus Hamburg Bergedorf, Glindersweg 80, 21029, Hamburg, Deutschland
| |
Collapse
|