An elderly-onset rheumatic syndrome: is it RS3PE?

Submitted: 27 October 2016
Accepted: 6 January 2017
Published: 11 September 2017
Abstract Views: 1806
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Authors

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.

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Citations

Marta Oliveira, Internal Medicine Department, Centro Hospitalar Baixo Vouga, E.P.E. Aveiro
Department of Internal Medicine
Filipa Ferreira, Internal Medicine Department, Centro Hospitalar Baixo Vouga, E.P.E. Aveiro
Department of Internal Medicine
Erica Ferreira, Internal Medicine Department, Centro Hospitalar Baixo Vouga, E.P.E. Aveiro
Department of Internal Medicine
Rosa Jorge, Internal Medicine Department, Centro Hospitalar Baixo Vouga, E.P.E. Aveiro
Department of Internal Medicine.

How to Cite

Oliveira, M., Ferreira, F., Ferreira, E., & Jorge, R. (2017). An elderly-onset rheumatic syndrome: is it RS3PE?. Italian Journal of Medicine, 11(3), 335–339. https://doi.org/10.4081/itjm.2017.806