SHM Converge Scientific Abstract ePoster Gallery-Boxing Glove Hands: A Rare Inflammatory Syndrome Affecting the Elderly

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A 71-year-old man with type 2 diabetes and hypothyroidism presented with 6 months of intermittent hand pain, swelling, numbness, and tingling. He had previously been diagnosed with carpal tunnel syndrome and underwent left carpal tunnel release 5 months earlier, but his left hand swelling worsened after surgery despite steroids. He also reported reduced grip strength and morning stiffness lasting about 30 minutes.<br /><br />On examination, he had synovitis of all PIP and MCP joints with pitting edema in both hands. Labs showed mildly elevated CRP and uric acid, but ESR, ANA, dsDNA, RF, anti-CCP, Scl-70, SSA/SSB, anti-Smith, and HLA-B27 were negative. Wrist x-rays showed no erosions.<br /><br />The presentation was consistent with remitting seronegative symmetrical synovitis with pitting edema (RS3PE), a rare syndrome formerly considered part of rheumatoid arthritis but now recognized as distinct. RS3PE typically causes sudden symmetric hand swelling with pitting edema, seronegative inflammatory arthritis, and an excellent response to corticosteroids. It may be associated with HLA-B7/HLA-A2 and possibly VEGF-related vascular permeability.<br /><br />The case highlights that RS3PE is often missed, leading to unnecessary procedures or prolonged symptoms, as occurred here with carpal tunnel surgery. Early recognition is important because treatment can rapidly relieve symptoms. Because RS3PE may be associated with underlying malignancy, patients should also be evaluated for possible neoplastic disease.

Asset Subtitle

Yasmin Rosshandler

Meta Tag

Author List Xena Whittier, Yasmin Rosshandler

Category Clinical Vignettes

Concept RS3PE

Concept Pitting Edema

Concept Synovitis

Concept Corticosteroids

Concept Hand

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital

Presenting Author Yasmin Rosshandler

Track Adult

Keywords

RS3PE

remitting seronegative symmetrical synovitis with pitting edema

pitting edema

synovitis

carpal tunnel syndrome

hand swelling

seronegative arthritis

corticosteroid response

type 2 diabetes

malignancy association

RS3PE

Pitting Edema

Synovitis

Corticosteroids

Hand