Skip to main content

Advertisement

SpringerLink
Log in

Differences in musculoskeletal ultrasound findings between RS3PE syndrome and elderly-onset rheumatoid arthritis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objective

To retrospectively analyze the differences in musculoskeletal ultrasound (MSUS) findings to distinguish patients with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome and patients with elderly-onset rheumatoid arthritis (EORA).

Methods

We consecutively recruited patients with RS3PE syndrome (n = 7) and EORA (n = 22) who underwent pre-treatment MSUS of both hands. Synovial hypertrophy and vascularity of articular synovitis and those of tenosynovitis of the digital flexor tendons and the carpal extensor tendon were evaluated by gray-scale and power Doppler, respectively on a semi-quantitative scale (0–3). The presence/absence of intra-articular synovial effusion, bone erosion, peritendinitis of the digital extensor tendon, and subcutaneous edema were noted.

Results

Compared to the EORA group, mild articular synovitis was observed more extensively, and the frequency of intra-articular synovial effusion was significantly higher in the RS3PE syndrome group. Severe articular synovial hypertrophy was more frequent in the EORA group compared to the RS3PE syndrome group, and bone erosion was observed in some EORA cases. Tenosynovitis of the digital flexor tendon was more frequent and severe in the RS3PE syndrome group compared to the EORA group. Although the frequency and severity of tenosynovitis of the carpal extensor tendon were similar in the two groups, digital extensor tendon peritendinitis was more frequent in the RS3PE syndrome group.

Conclusion

To distinguish patients with RS3PE syndrome from those with EORA, it is important to evaluate not only intra-articular lesions but also extra-articular lesions by MSUS.

Key Points

• We retrospectively compared MSUS findings of RS3PE syndrome and EORA in detail.

• MSUS revealed extensive intra- and extra-articular inflammation in patients with RS3PE syndrome

• Evaluating not only intra-articular lesions but also extra-articular lesions helps distinguish RS3PE syndrome and EORA

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ACPA:

Anti-cyclic citrullinated peptide antibody

CRP:

C-reactive protein

DMARD:

Disease-modifying antirheumatic drug

DRU:

Distal radio-ulna

ECU:

Extensor carpal ulnaris

EORA:

Elderly-onset rheumatoid arthritis

ESR:

Erythrocyte sedimentation rate

GS:

Gray-scale

IP:

Interphalangeal

IQR:

Interquartile range

JCR:

Japan College of Rheumatology

MCP:

Metacarpophalangeal

MSUS:

Musculoskeletal ultrasound

MRI:

Magnetic resonance imaging

PD:

Power Doppler

PIP:

Proximal interphalangeal

RA:

Rheumatoid arthritis

RC-IC:

Radiocarpal-intercarpal

RF:

Rheumatoid factor

RS3PE:

Remitting seronegative symmetrical synovitis with pitting edema

References

  1. McCarty DJ, O'Duffy JD, Pearson L, Hunter JB (1985) Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome. JAMA 254:2763–2767

    Article  CAS  Google Scholar 

  2. Olivé A, del Blanco J, Pons M, Vaquero M, Tena X (1997) The clinical spectrum of remitting seronegative symmetrical synovitis with pitting edema. The Catalán Group for the Study of RS3PE. J Rheumatol 24:333–336

    PubMed  Google Scholar 

  3. Karmacharya P, Donato AA, Aryal MR, Ghimire S, Pathak R, Shah K, Shrestha P, Poudel D, Wasser T, Subedi A, Giri S, Jalota L, Olivé A (2016) RS3PE revisited: a systematic review and meta-analysis of 331 cases. Clin Exp Rheumatol 34:404–415

    PubMed  Google Scholar 

  4. Origuchi T, Arima K, Umeda M, Kawashiri SY, Tamai M, Nakamura H, Tsukada T, Miyashita T, Iwanaga N, Izumi Y, Furuyama M, Tanaka F, Kawabe Y, Aramaki T, Ueki Y, Eguchi K, Fukuda T, Kawakami A (2017) Clinical outcomes in the first year of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. Mod Rheumatol 27:150–154

    Article  CAS  Google Scholar 

  5. Tan TC, Gao X, Thong BY, Leong KP, Lian TY, Law WG, Kong KO, Howe HS, Chng HH, Koh ET, TTSH Rheumatoid Arthritis Study Group (2017) Comparison of elderly- and young-onset rheumatoid arthritis in an Asian cohort. Int J Rheum Dis 20:737–745

    Article  CAS  Google Scholar 

  6. Cantini F, Salvarani C, Olivieri I, Barozzi L, Macchioni L, Niccoli L et al (1999) Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome: a prospective follow up and magnetic resonance imaging study. Ann Rheum Dis 58:230–236

    Article  CAS  Google Scholar 

  7. Arima K, Origuchi T, Tamai M, Iwanaga N, Izumi Y, Huang M, Tanaka F, Kamachi M, Aratake K, Nakamura H, Ida H, Uetani M, Kawakami A, Eguchi K (2005) RS3PE syndrome presenting as vascular endothelial growth factor associated disorder. Ann Rheum Dis 64:1653–1655

    Article  CAS  Google Scholar 

  8. Agarwal V, Dabra AK, Kaur R, Sachdev A, Singh R (2005) Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome: ultrasonography as a diagnostic tool. Clin Rheumatol 24:476–479

    Article  Google Scholar 

  9. Klauser A, Frauscher F, Halpern EJ, Mur E, Springer P, Judmaier W, Schirmer M (2005) Remitting seronegative symmetrical synovitis with pitting edema of the hands: ultrasound, color doppler ultrasound, and magnetic resonance imaging findings. Arthritis Rheum 53:226–233

    Article  Google Scholar 

  10. Kawashiri SY, Nakano M, Kawakami A, Eguchi K (2010) Monitoring of therapeutic efficacy in a patient with RS3PE syndrome by serologic variables and radiographic methods. Rheumatol Int 30:1677–1680

    Article  Google Scholar 

  11. Kawashiri SY, Suzuki T, Okada A, Yamasaki S, Tamai M, Nakamura H, Origuchi T, Mizokami A, Uetani M, Aoyagi K, Eguchi K, Kawakami A (2013) Musculoskeletal ultrasonography assists the diagnostic performance of the 2010 classification criteria for rheumatoid arthritis. Mod Rheumatol 23:36–43

    Article  Google Scholar 

  12. Kawashiri SY, Fujikawa K, Nishino A, Takatani A, Shimizu T, Umeda M, Fukui S, Igawa T, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Mizokami A, Maeda T, Kawakami A (2019) Combination of ultrasound power Doppler-verified synovitis and seropositivity accurately identifies patients with early-stage rheumatoid arthritis. Int J Rheum Dis 22:842–851

    Article  CAS  Google Scholar 

  13. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd et al (2010) Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69(9):1580–1588 and Arthritis Rheum 62(9):2569–2581

  14. Torp-Pedersen ST, Terslev L (2008) Settings and artefacts relevant in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis 67:143–149

    Article  CAS  Google Scholar 

  15. Hammer HB, Bolton-King P, Bakkeheim V, Berg TH, Sundt E, Kongtorp AK, Haavardsholm EA (2011) Examination of intra and interrater reliability with a new ultrasonographic reference atlas for scoring of synovitis in patients with rheumatoid arthritis. Ann Rheum Dis 70:1995–1998

    Article  Google Scholar 

  16. D’Agostino MA, Terslev L, Aegerter P, Backhaus M, Balint P, Bruyn GA et al (2017) Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-part 1: definition and development of a standardised, consensus-based scoring system. RMD Open 3:e000428

    Article  Google Scholar 

  17. Naredo E, D'Agostino MA, Wakefield RJ, Möller I, Balint PV, Filippucci E et al (2013) Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 72:1328–1334

    Article  Google Scholar 

  18. Gutierrez M, Filippucci E, Salaffi F, Di Geso L, Grassi W (2011) Differential diagnosis between rheumatoid arthritis and psoriatic arthritis: the value of ultrasound findings at metacarpophalangeal joints level. Ann Rheum Dis 70:1111–1114

    Article  Google Scholar 

  19. Kawashiri SY, Kawakami A, Iwamoto N, Fujikawa K, Satoh K, Tamai M et al (2011) The power Doppler ultrasonography score from 24 synovial sites or 6 simplified synovial sites, including the metacarpophalangeal joints, reflects the clinical disease activity and level of serum biomarkers in patients with rheumatoid arthritis. Rheumatology (Oxford) 50:962–965

    Article  Google Scholar 

Download references

Acknowledgments

None.

Author information

Authors and Affiliations

  1. Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan

    Shin-ya Kawashiri, Sousuke Tsuji, Ayuko Takatani, Toshimasa Shimizu, Tomohiro Koga, Naoki Iwamoto, Kunihiro Ichinose, Hideki Nakamura, Tomoki Origuchi & Atsushi Kawakami

  2. Department of Rheumatology, Sasebo City General Hospital, Sasebo, Japan

    Takahisa Suzuki

  3. Department of Rheumatology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan

    Akitomo Okada

Authors
  1. Shin-ya Kawashiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takahisa Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akitomo Okada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sousuke Tsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ayuko Takatani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toshimasa Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tomohiro Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Naoki Iwamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kunihiro Ichinose
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hideki Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tomoki Origuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Atsushi Kawakami
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shin-ya Kawashiri.

Ethics declarations

Disclosures

None.

Ethical approval

The study was approved by the Institutional Review Board (reference no. 10062546) of Nagasaki University Hospital.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kawashiri, Sy., Suzuki, T., Okada, A. et al. Differences in musculoskeletal ultrasound findings between RS3PE syndrome and elderly-onset rheumatoid arthritis. Clin Rheumatol 39, 1981–1988 (2020). https://doi.org/10.1007/s10067-020-04931-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-020-04931-w

Keywords

Search

Navigation