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a message whose ingenuity or verbal skill or incongruity has the power to evoke laughter (同)humor, humour, witticism, wittiness
swelling from excessive accumulation of watery fluid in cells, tissues, or serous cavities (同)oedema, hydrops, dropsy
having similarity in size, shape, and relative position of corresponding parts (同)symmetric
inflammation of the synovial membrane that lines a synovial joint; results in pain and swelling

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《随伴・協調》…『と』,と共に,といっしょに / 《所有・所持》…『を持っている』,がある,の付いた / 《道具・手段》…『で』,を使って / 《財料・供給物》…『で』,を与えて / …を支持して,に賛成して / …『に反対(敵対)して』,を相手として / …『と同時に』,と同様に / …『に比べて』,に比例して / 《様態》《名詞を伴い副詞句として》『…で』,を示して,をもって / 《付帯状競》…『して』,しながら / 《譲歩》…がありながら,にもかかわらず / 『…が原因で』,のために,…で / …に任せて,のもとにあずけて,のところに / …に関して,について / …から離れて / 《連結・混合》…と / 《副詞と共に命令文で》
知る(know)
〈U〉『機知』,機転,ウィット / 〈C〉『機知に富む人』,機転のきく人 / 《複数形で;単数扱い》『理解(表現)力』,知性 / 《複数形で》(物事を見抜いたりもくろんだりする)才覚,才知 / 《複数形で;単数扱い》正気
浮腫(ふしゅ),水腫

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/08/21 14:43:53」(JST)

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Remitting seronegative symmetrical synovitis with pitting edema (abbreviated RS3PE or sometimes RS₃PE) is a rare syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema of the back of the hands and/or feet, and a negative serum rheumatoid factor.^[1] If no underlying disorder can be identified (idiopathic RS3PE), this entity has an excellent prognosis and responds well to treatment.^[2]

RS3PE typically involves the joints of the extremities, specifically the metacarpophalangeal and proximal interphalangeal joints, wrists, shoulders, elbows, knees and ankles.^[3] It is more common in older adults, with the mean age between 70 and 80 years in most studies.^[3]^[4] It occurs more often in men than in women with a 2:1 ratio.^[3]^[5]^[6] It is unknown how common this condition is.

Causes[edit source | edit]

RS3PE is a constellation of symptoms that can be caused by many other conditions. Since there is no definitive diagnostic test, other conditions have to be ruled out before this rare condition can be diagnosed.

The main differential diagnosis is polymyalgia rheumatica (PMR), although pain, stiffness and weakness at the level of the shoulders and pelvic girdle with associated systemic symptoms (fever, malaise, fatigue, weight loss) is more typical of PMR. Prospective studies have found a subgroup of PMR patients with hand edema, as well as other similarities.^[4] Thus, RS3PE has been proposed as a condition related to PMR or even that they are both part of the same disorder.^[4] However, PMR typically requires protracted courses of steroids, whereas corticosteroids can be tapered more quickly with persisting remission in RS3PE.^[4]

Other rheumatological disorders that can cause the features typical for RS3PE include late onset (seronegative) rheumatoid arthritis, acute sarcoidosis, ankylosing spondylitis and other spondyloarthropathies such as psoriatic arthropathy, mixed connective tissue disease, chondrocalcinosis and arthropathy due to amyloidosis.^[5]^[7]

RS3PE has been documented in patients with cancers (Non-Hodgkin's lymphoma, gastric cancer, pancreatic cancer, lung cancer, breast cancer, colon cancer, prostate cancer and bladder cancer, among others), in whom it might represent a paraneoplastic manifestation.^[8]^[9]^[10] Other underlying disorders include vasculitides such as polyarteritis nodosa.^[7]

Other causes of edema include heart failure, hypoalbuminemia, nephrotic syndrome and venous stasis. The key distinguishing feature is that these conditions don't tend to manifest with pitting edema at the back of the hands.

Diagnosis[edit source | edit]

Ultrasonography and magnetic resonance imaging of the hands and/or feet have been proposed as useful diagnostic investigations in RS3PE.^[11]

Some studies linked RS3PE to HLA-B27 whereas others have not.

Treatment[edit source | edit]

RS3PE responds excellently to low dose corticosteroids, with sustained and often complete remission. Non-steroidal anti-inflammatory drugs (NSAIDs) have also been used. Hydroxychloroquine has proven effective in some cases.^[5]

Disease mechanism[edit source | edit]

The disease mechanism (pathophysiology) of RS3PE remains unknown. One study suggested a possible role for vascular endothelial growth factor.^[12] A study using magnetic resonance imaging found that tenosynovitis of the extensors of the hands and feet is the major contributor to edema.^[13]

History[edit source | edit]

In a 1985 paper published in the Journal of the American Medical Association, McCarty and colleagues first described a case series of patients with this disorder, for which they coined the abbreviation RS3PE.^[14]

Footnotes[edit source | edit]

^ Olivieri I, Salvarani C, Cantini F (2000). "RS3PE syndrome: an overview". Clin. Exp. Rheumatol. 18 (4 Suppl 20): S53–5. PMID 10948764.
^ Queiro R (March 2004). "RS3PE syndrome: a clinical and immunogenetical study". Rheumatol. Int. 24 (2): 103–5. doi:10.1007/s00296-003-0330-3. PMID 12750942.
^ ^a ^b ^c Olivé A, del Blanco J, Pons M, Vaquero M, Tena X (February 1997). "The clinical spectrum of remitting seronegative symmetrical synovitis with pitting edema. The Catalán Group for the Study of RS3PE.". J. Rheumatol. 24 (2): 333–6. PMID 9034993.
^ ^a ^b ^c ^d Cantini F, Salvarani C, Olivieri I, et al. (April 1999). "Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome: a prospective follow up and magnetic resonance imaging study". Ann. Rheum. Dis. 58 (4): 230–6. doi:10.1136/ard.58.4.230. PMC 1752869. PMID 10364902.
^ ^a ^b ^c Salam A, Henry R, Sheeran T (2008). "Acute onset polyarthritis in older people: Is it RS3PE syndrome?". Cases J 1 (1): 132. doi:10.1186/1757-1626-1-132. PMC 2543002. PMID 18759976.
^ Hartley AJ, Manson J, Jawad ASM (2010). "Remitting seronegative symmetrical synovitis with pitting oedema.". Grand Rounds 10: 71–73. doi:10.1102/1470-5206.2010.0015.
^ ^a ^b Díez-Porres L, Muñoz-Fernández S, Aguado P, Alonso M, Martín-Mola E (November 2002). "Remitting seronegative symmetrical synovitis with pitting oedema as the first manifestation of psoriatic arthropathy". Rheumatology (Oxford) 41 (11): 1333–5. doi:10.1093/rheumatology/41.11.1333-a. PMID 12422012.
^ Russell EB (September 2005). "Remitting seronegative symmetrical synovitis with pitting edema syndrome: followup for neoplasia". J. Rheumatol. 32 (9): 1760–1. PMID 16142875.
^ Fietta P, Manganelli P (November 2006). "Remitting seronegative symmetrical synovitis with pitting edema syndrome: followup for neoplasia". J. Rheumatol. 33 (11): 2365–6; author reply 2366. PMID 17086622. ^{[dead link]}
^ Bucaloiu ID, Olenginski TP, Harrington TM (December 2007). "Remitting seronegative symmetrical synovitis with pitting edema syndrome in a rural tertiary care practice: a retrospective analysis". Mayo Clin. Proc. 82 (12): 1510–5. doi:10.4065/82.12.1510. PMID 18053459. ^{[dead link]}
^ Agarwal V, Dabra AK, Kaur R, Sachdev A, Singh R (September 2005). "Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome: ultrasonography as a diagnostic tool". Clin. Rheumatol. 24 (5): 476–9. doi:10.1007/s10067-004-1061-x. PMID 15856369.
^ Arima K, Origuchi T, Tamai M, et al. (November 2005). "RS3PE syndrome presenting as vascular endothelial growth factor associated disorder". Ann. Rheum. Dis. 64 (11): 1653–5. doi:10.1136/ard.2004.032995. PMC 1755286. PMID 16227418.
^ Olivieri I, Salvarani C, Cantini F (February 1997). "Remitting distal extremity swelling with pitting edema: a distinct syndrome or a clinical feature of different inflammatory rheumatic diseases?". J. Rheumatol. 24 (2): 249–52. PMID 9034979.
^ McCarty DJ, O'Duffy JD, Pearson L, Hunter JB (November 1985). "Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome". JAMA 254 (19): 2763–7. doi:10.1001/jama.254.19.2763. PMID 4057484.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. リウマチ性多発筋痛の臨床症状および診断 clinical manifestations and diagnosis of polymyalgia rheumatica
2. 悪性腫瘍およびリウマチ性疾患 malignancy and rheumatic disorders
3. 再発性多発性軟骨炎の臨床症状 clinical manifestations of relapsing polychondritis
4. 巨細胞（側頭）動脈炎の臨床症状 clinical manifestations of giant cell temporal arteritis
5. 全身性疾患のミオパシー myopathies of systemic disease

English Journal

Remitting seronegative symmetrical synovitis with pitting edema syndrome in individuals with type 2 diabetes mellitus or impaired glucose tolerance.

Oyama K1, Taniguchi J2, Goto R1, Matsui K1.
Diabetes research and clinical practice.Diabetes Res Clin Pract.2015 Oct;110(1):e5-8. doi: 10.1016/j.diabres.2015.06.007. Epub 2015 Jul 29.
An association between remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome and insulin or dipeptidyl peptidase-4 (DPP4) inhibitor therapy were previously reported. We encountered four cases of RS3PE syndrome with type 2 diabetes mellitus or impaired glucose tolerance (IG
PMID 26293448

Remitting seronegative symmetrical synovitis with pitting edema associated with parvovirus B19 infection: two new cases and review of the comorbidities.

Drago F1, Ciccarese G1, Agnoletti AF1, Cogorno L1, Muda A2, Cozzani E1, Parodi A1.
International journal of dermatology.Int J Dermatol.2015 Oct;54(10):e389-93. doi: 10.1111/ijd.12854. Epub 2015 Jul 3.
BACKGROUND: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare syndrome consisting of acute symmetrical tenosynovitis of the hands and wrists associated with pain and marked pitting edema of the dorsum of the hands or the feet. Persistent rheumatoid factor seronegativi
PMID 26147127

RS3PE: Clinical and Research Development.

Li H1, Altman RD, Yao Q.
Current rheumatology reports.Curr Rheumatol Rep.2015 Aug;17(8):49. doi: 10.1007/s11926-015-0525-0.
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
PMID 26113011

Japanese Journal

High serum matrix metalloproteinase 3 is characteristic of patients with paraneoplastic remitting seronegative symmetrical synovitis with pitting edema syndrome

ORIGUCHI Tomoki,ARIMA Kazuhiko,KAWASHIRI Shin-ya,TAMAI Mami,YAMASAKI Satoshi,NAKAMURA Hideki,TSUKADA Toshiaki,ARAMAKI Toshiyuki,FURUYAMA Masako,MIYASHITA Taiichiro,KAWABE Yojiro,IWANAGA Nozomi,TERADA Kaoru,UEKI Yukitaka,FUKUDA Takaaki,EGUCHI Katsumi,KAWAKAMI Atsushi
Modern rheumatology 22(4), 584-588, 2012-08-01
NAID 10031027205

維持透析患者で Remitting Seronegative Symmetrical Synovitis with Pitting Edema(RS3PE) 症候群が疑われた1例

平尾圭市,松浦友一,伊従正博
日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 44(12), 1177-1183, 2011-12-28
… Remitting Seronegative Symmetrical Synovitis with Pitting Edema(RS3PE）症候群は1985年にMcCartyらが高齢者においてリウマチ因子陰性かつ多関節炎をきたす病態として提唱されたが，維持透析患者での発症例の報告は少ない．われわれは維持透析患者でRS3PE症候群が疑われた症例を経験したので報告する．症例は2004年か …
NAID 10030389775

Related Pictures

Remitting Seronegative Symmetrical Synovitis with Pitting Edema Image of the month: Remitting seronegative symmetrical synovitis with pitting oedema Serum matrix metalloproteinase 3 in detecting remitting seronegative symmetrical RS3PE - Remitting seronegative symmetrical synovitis with pitting edema Figure 1 | Remitting Seronegative Symmetrical Synovitis with Pitting Carpal tunnel syndrome caused by remitting seronegative symmetrical synovitis with