Remitting seronegative symmetrical synovitis with pitting edema (RS3PE): Aform of paraneoplastic polyarthritis?

Objective. To describe the clinical and laboratory features and outcome of 6 patients presenting with remitting seronegative symmetrical synovitis wit h pitting edema (RS3PE) revealing a solid tumor. Methods. Patients with RS3PE who presented with a solid tumor and who had b een seen between January 1, 1994, and December 31, 1996, were included in a retrospective multicenter analysis. These patients fulfilled McCarty's des cription of RS3PE and the following criteria: (1) bilateral pitting edema o f both hands, (2) sudden onset of polyarthritis, (3) age > 50 years, and (4 ) absence of rheumatoid factor (RF). Results, Six male patients with RS3PE are described, of mean age 74 years ( range 72-78), presenting prostatic (n = 4), gastric (n = 1), and colic (n = 1) adenocarcinomas. The clinical picture was characterized by the classica l form of RS3PE syndrome and by a deterioration in general condition, somet imes with fever. All patients were negative for RF and antinuclear antibodi es. In 2 cases of prostatic adenocarcinoma serum levels of interleukin 6 (I L-6) were high, but decreased with treatment. In these 6 patients, the arti cular manifestations regressed totally or partially in response to corticos teroids, sometimes at low doses, associated in most cases with specific ant itumoral therapy. None displayed erosion or distal bone destruction. The me an survival following discovery of RS3PE was 11 months (range 6-18), 5 pati ents dying of metastatic dissemination of their cancer and the 6th of myoca rdial infarction. Conclusion. RS3PE is a heterogeneous syndrome that can reveal a solid tumor , notably an adenocarcinoma. There exist no specific criteria to define its forms, but this syndrome should be kept in mind in the face of a deteriora tion in general health. Although the pathogenic mechanism is unknown, this could involve a type of paraneoplastic polyarthritis linked to the synthesi s of a factor such as IL-6.