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Oct 2012

Remitting Seronegative Symmetrical Synovitis With Pitting Edema

Author Affiliations

Author Affiliations: Departments of Dermatology and Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Arch Dermatol. 2012;148(10):1217-1218. doi:10.1001/archdermatol.2012.2144

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is characterized by symmetrical edema of the dorsal surfaces of the hands, a negative rheumatoid factor, and absence of bony erosions even in the presence of articular lesions. We present a case highlighting the clinical manifestations of RS3PE.

A 71-year-old woman with a history of hyperlipidemia presented with symmetric, stiffened, pitting edema of the dorsal surfaces of the hands that had progressed during a period of 2 weeks (Figure, A). The patient did not have a history of Raynaud phenomenon. Skin color change, periungual telangiectasia, and contractures were not noted. Laboratory findings for rheumatoid factor, Scl-70, ribonuclear protein U1, and anti-centromere were negative; the antinuclear antibody titer was 1:40 showing a cytoplasmic pattern. Radiographic examination of the hands showed neither narrowing of the joint spaces nor bony erosions. Bone scintigraphy revealed synovitis of the wrists (Figure, B). Histopathologic examination showed no specific changes of the epidermis. The dermis showed lymphocytic infiltrates and solar elastosis. No significant changes in the collagen bundles were noted. Deposition of material such as increased mucin was not observed. Oral administration of prednisolone, 15 mg/d, was initiated, and the edema subsided. The prednisolone dose was tapered and cut after 3 months.

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