An elderly-onset rheumatic syndrome: is it RS3PE?

It is presented a case of a 75-year-old Caucasian male patient who was admitted to hospital with a history of painful swollen hands and feet, associated with worsening mobility. Examination revealed bilateral pitting edema of dorsum of hands and feet. Initial blood test showed 10.7 g/L hemoglobin with normochromic and normocytic anemia, raised inflammatory markers (erythrocyte sedimentation rate 60 mm, C-reactive protein 16.73 mg/dL) and normal white blood cells count. Autoantibody screen and rheumatoid factor were negative, with positive HLA-B27. Radiological findings of hands and feet did not show any erosions. The patient was also screened and investigated for associated malignancies; the tumor markers and the computed tomography thorax/abdomen were reported as normal. The patient responded extremely well to low dose prednisolone at 20 mg daily dosage. Further follow up 5 weeks later on tapering dose of prednisolone showed complete resolution of signs and symptoms without any further flare-ups. Remitting seronegative symmetrical synovitis with pitting edema is a definite syndrome, a rare subset of polyarthritis with favorable outcome and has a good prognosis in older patients. This case illustrates the interesting diagnosis exercise that is needed, once the multiple conditions that may be related with the disease support that this is a syndrome with potentially heterogeneous etiologies. Looking for underlying malignancy is recommended.