Skip to main content

Advertisement

Log in

RS3PE: Clinical and Research Development

  • Orphan Diseases (B Manger, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Remitting seronegative symmetrical synovitis with pitting edema or RS3PE is a rare elderly-onset rheumatic syndrome. Although there are overlapping clinical manifestations between RS3PE, elderly-onset rheumatoid arthritis, and polymyalgia rheumatica, RS3PE has distinct characteristics. RS3PE can be associated with neoplasia and various rheumatic conditions, suggesting that it may be heterogeneous, and is considered as a paraneoplastic rheumatic disease. The pathogenesis of RS3PE may involve vascular endothelial growth factor and infection in RS3PE based upon limited data. Patients with RS3PE without concomitant malignancy respond well to small doses of glucocorticoids and carry good prognosis.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. McCarty DJ, O’Duffy JD, Pearson L, Hunter JB. Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome. JAMA. 1985;254:2763–7.

    Article  CAS  PubMed  Google Scholar 

  2. Bhakta BB, Pease CT. Late-onset rheumatoid arthritis: is pitting oedema of the hands at onset a good prognostic indicator? Br J Rheumatol. 1997;36:214–9.

    Article  CAS  PubMed  Google Scholar 

  3. Mavragani CP, Moutsopoulos HM. Rheumatoid arthritis in the elderly. Exp Gerontol. 1999;34:463–71.

    Article  CAS  PubMed  Google Scholar 

  4. Schaeverbeke T, Vernhes JP, Bannwarth B, Dehais J. Is remitting seronegative symmetrical synovitis with pitting oedema (RS3PE syndrome) associated with HLA-A2? Br J Rheumatol. 1995;34:889–90.

    Article  CAS  PubMed  Google Scholar 

  5. Russell EB. Remitting seronegative symmetrical synovitis with pitting edema syndrome: followup for neoplasia. J Rheumatol. 2005;32:1760–1.

    PubMed  Google Scholar 

  6. Toussirot E, Berthier S, Wendling D, Tiberghien P. Lack of association between HLA DRB1* alleles and RS3PE syndrome. Ann Rheum Dis. 1998;57:442.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Serrano Ostoa B, Alvarez Hernández E. Remmiting symmetric seronegative synovitis with pitting edema (RS3PE). Reumatol Clin. 2012;8(3):156--7. doi:10.1016/j.reuma.2011.05.008.

  8. Varshney AN, Kumar N, Tiwari A, et al. Unilateral RS3PE in a patient of seronegative rheumatoid arthritis. Case Rep Rheumatol. 2013;2013:923797.

    PubMed Central  PubMed  Google Scholar 

  9. Nygaard U, Vestergaard C, Koppelhus U. Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) of hands and feet in an 83-year-old man. Acta Derm Venereol. 2013;93:491–2.

    Article  PubMed  Google Scholar 

  10. Ozsahin M, Ataoglu S, Turan H. Unilateral RS3PE with young-onset rheumatoid arthritis. Semin Arthritis Rheum. 2011;40:e1.

    Article  PubMed  Google Scholar 

  11. Keenan RT, Hamalian GM, Pillinger MH. RS3PE presenting in a unilateral pattern: case report and review of the literature. Semin Arthritis Rheum. 2009;38:428–33.

    Article  PubMed  Google Scholar 

  12. Kimura M, Tokuda Y, Oshiawa H, et al. Clinical characteristics of patients with remitting seronegative symmetrical synovitis with pitting edema compared to patients with pure polymyalgia rheumatica. J Rheumatol. 2012;39:148–53. This is a comparative study between RS3PE and PMR.

    Article  PubMed  Google Scholar 

  13. Bucaloiu ID, Olenginski TP, Harrington TM. Remitting seronegative symmetrical synovitis with pitting edema syndrome in a rural tertiary care practice: a retrospective analysis. Mayo Clin Proc. 2007;82:1510–5.

    Article  PubMed  Google Scholar 

  14. Okumura T, Tanno S, Ohhira M, Nozu T. The rate of polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in a clinic where primary care physicians are working in Japan. Rheumatol Int. 2012;32:1695–9.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Yao Q, Su X, Altman RD. Is remitting seronegative symmetrical synovitis with pitting edema (RS3PE) a subset of rheumatoid arthritis? Semin Arthritis Rheum. 2010;40:89–94.

    Article  PubMed  Google Scholar 

  16. Sugihara T, Ishizaki T, Hosoya T et al. Structural and functional outcomes of a therapeutic strategy targeting low disease activity in patients with elderly-onset rheumatoid arthritis: a prospective cohort study (CRANE). Rheumatology (Oxford) 2014 Oct 8. pii:keu395. [Epub ahead of print].

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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Agarwal V, Dabra AK, Kaur R, et al. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome: ultrasonography as a diagnostic tool. Clin Rheumatol. 2005;24:476–9.

    Article  PubMed  Google Scholar 

  19. Gisserot O, Cremades S, Landais C, et al. RS3PE revealing recurrent non-Hodgkin’s lymphoma. Joint Bone Spine. 2004;71:424–6.

    Article  PubMed  Google Scholar 

  20. Tunc SE, Arslan C, Ayvacioglu NB, et al. Paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome): a report of two cases and review of the literature. Rheumatol Int. 2004;24:234–7.

    Article  PubMed  Google Scholar 

  21. Paira S, Graf C, Roverano S, Rossini J. Remitting seronegative symmetrical synovitis with pitting oedema: a study of 12 cases. Clin Rheumatol. 2002;21:146–9.

    Article  CAS  PubMed  Google Scholar 

  22. Vinci M, Malaguarnera L, Pistone G. RS3PE and ovarian cancer. Ann Rheum Dis. 2001;60:429–31.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Goldenberg K, Rozenbaum M, Rosner I, et al. Remitting symmetric seronegative synovitis with pitting edema (RS3PE) secondary to non-Hodgkin’s lymphoma. Clin Exp Rheumatol. 1998;16:767–8.

    CAS  PubMed  Google Scholar 

  24. Cobeta-Garcia JC, Domingo-Morera JA, Martinez-Burgui J. RS3PE syndrome and chronic lymphoid leukaemia. Clin Exp Rheumatol. 1999;17:266–7.

    CAS  PubMed  Google Scholar 

  25. Chiappetta N, Gruber B. Remitting seronegative symmetrical synovitis with pitting edema associated with acute myeloid leukemia. J Rheumatol. 2005;32:1613–4.

    PubMed  Google Scholar 

  26. Ekenel M, Yavuz S, Karti S, et al. Remitting seronegative symmetrical synovitis with pitting oedema associated with chronic lymphocytic leukaemia. Clin Rheumatol. 2000;19:247–8.

    Article  CAS  PubMed  Google Scholar 

  27. Manganelli P, Delsante G, Bianchi G, et al. Remitting seronegative symmetrical synovitis with pitting oedema in a patient with myelodysplastic syndrome and relapsing polychondritis. Clin Rheumatol. 2001;20:132–5.

    Article  CAS  PubMed  Google Scholar 

  28. Tabeya T, Sugaya T, Suzuki C et al. A case of angioimmunoblastic T-cell lymphoma with high serum VEGF preceded by RS3PE syndrome. Mod Rheumatol. 2013.

  29. Sibilia J, Friess S, Schaeverbeke T, et al. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE): a form of paraneoplastic polyarthritis? J Rheumatol. 1999;26:115–20.

    CAS  PubMed  Google Scholar 

  30. Ethiopia A, Bell D. Gastric carcinoma in association with remitting seronegative symmetrical synovitis with pitting edema. J Rheumatol. 1999;26:1203–4.

    CAS  PubMed  Google Scholar 

  31. Tada Y, Sato H, Yoshizawa S, et al. Remitting seronegative symmetrical synovitis with pitting edema associated with gastric carcinoma. J Rheumatol. 1997;24:974–5.

    CAS  PubMed  Google Scholar 

  32. Mattace-Raso FU, van der Cammen TJ. Remitting seronegative symmetrical synovitis with pitting oedema associated with lung malignancy. Age Ageing. 2007;36:470–1.

    Article  PubMed  Google Scholar 

  33. Olivo D, Mattace R. Concurrence of benign edematous polysynovitis in the elderly (RS3PE syndrome) and endometrial adenocarcinoma. Scand J Rheumatol. 1997;26:67–8.

    Article  CAS  PubMed  Google Scholar 

  34. Smitten AL, Simon TA, Hochberg MC, Suissa S. A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis. Arthritis Res Ther. 2008;10:R45.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Gross RL, Schwartzman-Morris JS, Krathen M, et al. A comparison of the malignancy incidence among patients with psoriatic arthritis and patients with rheumatoid arthritis in a large US cohort. Arthritis Rheumatol. 2014;66:1472–81. This is a new study of malignancy rate in rheumatoid arthritis.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Yamada T, Nakajima A, Inoue E, et al. Incidence of malignancy in Japanese patients with rheumatoid arthritis. Rheumatol Int. 2011;31:1487–92.

    Article  PubMed  Google Scholar 

  37. Muller S, Hider SL, Belcher J, et al. Is cancer associated with polymyalgia rheumatica? A cohort study in the general practice research database. Ann Rheum Dis. 2014;73:1769–73.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Azar L, Khasnis A. Paraneoplastic rheumatologic syndromes. Curr Opin Rheumatol. 2013;25:44–9.

    Article  PubMed  Google Scholar 

  39. Manger B, Schett G. Paraneoplastic syndromes in rheumatology. Nat Rev Rheumatol. 2014;10:662–70. This is a recent review of malignancies in rheumatology where the concept of paraneoplastic syndromes were defined, including RS3PE.

    Article  CAS  PubMed  Google Scholar 

  40. Hegazi MO, Saleh F, Al Rashidi A, Yaktien MM. Synovitis with pitting edema as the presenting manifestation of systemic lupus erythematosus. Lupus. 2014;23:1069–72.

    Article  CAS  PubMed  Google Scholar 

  41. Sugisaki K, Hirose T. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome following spontaneous rupture of a gouty tophus. Mod Rheumatol. 2008;18:630–3.

    Article  PubMed  Google Scholar 

  42. Fietta P, Manganelli P. Sjogren’s syndrome presenting as remitting seronegative symmetric synovitis with pitting edema (RS3PE): comment of the article by Choi et al. J Korean Med Sci. 2003;18:921.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Billey T, Navaux F, Lassoued S. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) as the first manifestation of periarteritis nodosa. Report of a case. Rev Rhum Engl Ed. 1995;62:53–4.

    CAS  PubMed  Google Scholar 

  44. Koeger AC, Karmochkine M, Chaibi P. RS3PE syndrome associated with advanced ankylosing spondylitis. J Rheumatol. 1995;22:375–6.

    CAS  PubMed  Google Scholar 

  45. Matsuda M, Sakurai K, Fushimi T, et al. Sarcoidosis with high serum levels of vascular endothelial growth factor (VEGF), showing RS3PE-like symptoms in extremities. Clin Rheumatol. 2004;23:246–8.

    Article  PubMed  Google Scholar 

  46. Magy N, Michel F, Auge B, et al. Amyloid arthropathy revealed by RS3PE syndrome. Joint Bone Spine. 2000;67:475–7.

    CAS  PubMed  Google Scholar 

  47. Kato T, Ubara Y, Sawa N, et al. An abrupt onset of seropositive polyarthritis with prominent distal tenosynovitis concomitant with bronochiolitis obliterans organizing pneumonia (BOOP): consideration of the relationship with RS3PE syndrome. Intern Med. 2004;43:143–7.

    Article  PubMed  Google Scholar 

  48. Sakoda H, Ito S, Kanda H, et al. Association between type 1 diabetes mellitus and remitting seronegative symmetrical synovitis with pitting edema: a case report. Diabetes Res Clin Pract. 2011;91:e43–4.

    Article  PubMed  Google Scholar 

  49. Yamauchi K, Sato Y, Yamashita K, et al. RS3PE in association with dipeptidyl peptidase-4 inhibitor: report of two cases. Diabetes Care. 2012;35:e7.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Smyth D, Rehman R, Remund K, Egan J. Remitting seronegative symmetrical synovitis with pitting oedema associated with rifampicin. Ir J Med Sci. 2011;180:585–6.

    Article  CAS  PubMed  Google Scholar 

  51. Mainali NR, Schmidt TR, Alweis R, George DL. Novel development of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome due to insulin therapy. Am J Case Rep. 2014;15:119–22.

    Article  PubMed Central  PubMed  Google Scholar 

  52. El Mahou S, Popa L, Constantin A, et al. Remitting seronegative symmetrical synovitis pitting oedema after BCG instillation. Clin Rheumatol. 2006;25:566–7.

    Article  PubMed  Google Scholar 

  53. Perandones CE, Colmegna I, Arana RM. Parvovirus B19: another agent associated with remitting seronegative symmetrical synovitis with pitting edema. J Rheumatol. 2005;32:389–90.

    PubMed  Google Scholar 

  54. Torres A, Cuende E, De Pablos M, et al. Remitting seronegative symmetrical synovitis with pitting edema associated with subcutaneous Streptobacillus moniliformis abscess. J Rheumatol. 2001;28:1696–8.

    CAS  PubMed  Google Scholar 

  55. Mittal K, Ebos J, Rini B. Angiogenesis and the tumor microenvironment: vascular endothelial growth factor and beyond. Semin Oncol. 2014;41:235–51.

    Article  CAS  PubMed  Google Scholar 

  56. Ku DD, Zaleski JK, Liu S, Brock TA. Vascular endothelial growth factor induces EDRF-dependent relaxation in coronary arteries. Am J Physiol. 1993;265:H586–92.

    CAS  PubMed  Google Scholar 

  57. Arima K, Origuchi T, Tamai M, et al. RS3PE syndrome presenting as vascular endothelial growth factor associated disorder. Ann Rheum Dis. 2005;64:1653–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Horai Y, Honda M, Nishino A, et al. Anti-citrullinated protein antibody-positive rheumatoid arthritis associated with RS3PE syndrome-like symptoms and an elevated serum vascular endothelial growth factor level in a patient with myasthenia gravis. Intern Med. 2014;53:895–8.

    Article  PubMed  Google Scholar 

  59. Oide T, Ohara S, Oguchi K, et al. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in Nagano, Japan: clinical, radiological, and cytokine studies of 13 patients. Clin Exp Rheumatol. 2004;22:91–8.

    CAS  PubMed  Google Scholar 

  60. Origuchi T, Arima K, Kawashiri SY, et al. High serum matrix metalloproteinase 3 is characteristic of patients with paraneoplastic remitting seronegative symmetrical synovitis with pitting edema syndrome. Mod Rheumatol. 2012;22:584–8.

    Article  CAS  PubMed  Google Scholar 

  61. Baumgartner I, Rauh G, Pieczek A, et al. Lower-extremity edema associated with gene transfer of naked DNA encoding vascular endothelial growth factor. Ann Intern Med. 2000;132:880–4.

    Article  CAS  PubMed  Google Scholar 

  62. van Schaardenburg D, Breedveld FC. Elderly-onset rheumatoid arthritis. Semin Arthritis Rheum. 1994;23:367–78.

    Article  PubMed  Google Scholar 

  63. Finnell JA, Cuesta IA. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome: a review of the literature and a report of three cases. J Foot Ankle Surg. 2000;39:189–93.

    Article  CAS  PubMed  Google Scholar 

  64. Queiro R. RS3PE syndrome: a clinical and immunogenetical study. Rheumatol Int. 2004;24:103–5.

    Article  CAS  PubMed  Google Scholar 

  65. Guma M, Casado E, Tena X, Olive A. RS3PE: six years later. Ann Rheum Dis. 1999;58:722–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Hongbin Li, Roy D. Altman, and Qingping Yao declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Qingping Yao.

Additional information

This article is part of the Topical Collection on Orphan Diseases

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, H., Altman, R.D. & Yao, Q. RS3PE: Clinical and Research Development. Curr Rheumatol Rep 17, 49 (2015). https://doi.org/10.1007/s11926-015-0525-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-015-0525-0

Keywords

Navigation