Clinical Rheumatology

, Volume 24, Issue 5, pp 476–479

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome: ultrasonography as a diagnostic tool

  • Vikas Agarwal
  • Ajay Kumar Dabra
  • Ravinder Kaur
  • Atul Sachdev
  • Ram Singh
Original Article

Abstract

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical synovitis and swelling of both the upper and lower extremities. The anatomical determinant of RS3PE is predominantly extensor tenosynovitis as revealed by magnetic resonance imaging (MRI). Given the cost constraints, time, and expertise required in carrying out MRI and ease in diagnosing tenosynovitis by ultrasound, we utilized high-frequency ultrasonography (USG) for evidence of tenosynovitis of the distal tendons in patients with RS3PE. Diagnosis of tenosynovitis was made on the basis of anechoic or hypoechoic signals around the tendon sheaths in both transverse and longitudinal planes. Flexor and extensor tendons at the wrist and metacarpal heads and extensor digitorum longus (EDL) tendons at the ankle were evaluated with a 7.5–10-MHz linear probe. There were ten patients (seven males) with a mean age of 59.5 years (range: 52–78 years) and mean disease duration of 6.1 months (range: 1.5–12 months). Disease onset was acute in all of the cases. Pitting edema of the hands was present in all except two patients whereas four patients, in addition, had edema of the feet. Edema was symmetrical in seven patients. Inability to make a complete fist was noted in all. Tenosynovitis of extensor and flexor tendons at the wrist and the metacarpal heads was documented in all patients with edema of the hands. In seven cases extensor tendon tenosynovitis was more prominent compared to the flexor tendons. Tenosynovitis of EDL tendons was detected in six cases. Dramatic relief with low-dose prednisolone was noted in all patients within 6 weeks of therapy. At a mean follow-up of 10.1 months all patients had marked relief in edema of extremities and improvement in the grip strength. Our study confirms that tenosynovitis of both flexor and extensor tendons at the wrist and extensor tendons of the feet is the hallmark of RS3PE syndrome. USG is a reliable and cost-effective modality for evaluation of patients with suspected RS3PE.

Keywords

Polymyalgia Rheumatoid Sarcoidosis Tenosynovitis 

References

  1. 1.
    McCarty DJ, O’Duffy JD, Pearson L, Hunter JB (1985) Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome. JAMA 254:2763–2767Google Scholar
  2. 2.
    Russel EB, Hunter JB, Pearson L, McCarty DJ (1990) Remitting seronegative symmetrical synovitis with pitting edema-13 additional cases. J Rheumatol 17:633–639Google Scholar
  3. 3.
    Cantini F, Salvarani C, Olivieri I, Barozzi L, Macchioni L, Niccoli L, Padula A, Pavlica P, Boiardi L (1999) Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome: a prospective follow up and magnetic resonance imaging study. Ann Rheum Dis 58:230–236Google Scholar
  4. 4.
    Olive A, del Blanco J, Pons M, Vaquero M, Tena X (1997) The clinical spectrum of remitting seronegative symmetrical synovitis with pitting edema. The Catalan Group for the study of RS3PE. J Rheumatol 24:333–336Google Scholar
  5. 5.
    Paira S, Graf C, Roverano S, Rossini J (2002) Remitting seronegative symmetrical synovitis with pitting oedema: a study of 12 cases. Clin Rheumatol 21:146–149Google Scholar
  6. 6.
    Olivieri I, Salvarani C, Cantini F (2000) RS3PE syndrome: an overview. Clin Exp Rheumatol 18:S53–S55Google Scholar
  7. 7.
    Pariser KM, Canoso JJ (1991) Remitting, seronegative (A) symmetrical synovitis with pitting edema–two cases of RS3PE syndrome. J Rheumatol 18:1260–1262Google Scholar
  8. 8.
    Martinoli C, Derchi LE, Pastorino C, Bertolotto M, Silvestri E (1993) Analysis of echotexture of tendons with US. Radiology 186:839–843Google Scholar
  9. 9.
    Scanlan KA (1991) Sonographic artifacts and their origins. AJR Am J Roentgenol 156:1267–1272Google Scholar
  10. 10.
    De Flaviis L, Musso MG (1995) Diseases of the tendons. In: Fornage BD (ed) Musculoskeletal ultrasound. Churchill Livingstone, New York, pp 154–158Google Scholar
  11. 11.
    Cantini F, Niccoli L, Olivieri I, Barozzi L, Pavlica P, Bozza A, Macchioni PL et al (1997) Remitting distal lower extremity swelling with pitting oedema in acute sarcoidosis. Ann Rheum Dis 56:565–572Google Scholar

Copyright information

© Clinical Rheumatology 2005

Authors and Affiliations

  • Vikas Agarwal
    • 1
    • 2
  • Ajay Kumar Dabra
    • 3
  • Ravinder Kaur
    • 3
  • Atul Sachdev
    • 2
  • Ram Singh
    • 2
  1. 1.Department of Clinical ImmunologySGPGIMSLucknowIndia
  2. 2.Department of MedicineGovernment Medical College and HospitalChandigarhIndia
  3. 3.Department of RadiodiagnosisGovernment Medical College and HospitalChandigarhIndia

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