RS3PE SYNDROME - A CLINICAL-DIAGNOSIS CHALLENGE FOR A GOOD PROGNOSIS

Introduction. - RS3PE syndrome (remittive symmetrical seronegative syn ovitis with pitting edema) was first described by MacCarthy in 1985. I t is a rare type of seronegative polyarthritis occurring in the elderl y. Methods. - Retrospective report of 13 cases (including eight male a nd five female patients; mean age 76.7 +/- 3.7 years) and search for p reviously reported cases, using the Medline(R) database. Results. - Pi tting edema was present at onset of disease in nine cases. Joint arthr itis was bilateral, occurring in the wrist (13 cases), shoulder (six c ases), elbow (six cases), knee (six cases), ankle (four cases), metaca rpophalangeal (four cases) and hip (one case). Radiographies were norm al. Mean erythrocyte sedimentation rate was 62 +/- 19 mm at the first hour and mean C-reactive protein level was 73 +/- 35 mg/L. Mild choles tasis was present in four of the seven patients for whom data were ava ilable. HLA B7 was present in five out of 12 cases (42%). Improvement was favorable, occurring over 7 months. Mean follow-up was 22.2 months . Fifty-nine other cases have been described in the literature. This s yndrome, which affects the elderly, appears to be rare. Its clinical p resentation is quite constant, with sudden onset, symmetrical polyarth ritis and pitting edema. Its evolution, often long, is favorable. Rheu matoid arthritis and polymyalgia rheumatica are the main differential diagnoses. Conclusion. - Due to its favorable outcome and the usefulne ss of a mild corticotherapy, this syndrome, though rare, should be dia gnosed where necessary in elderly patients. (C) 1998 Elsevier, Paris.