SHM Converge Scientific Abstract ePoster Gallery-The Diagnosis of Remitting Seronegative Symmetrical Synovitis With Pitting Edema in a Patient With Recurrent Prostate Cancer

The Diagnosis of Remitting Seronegative Symmetrical Synovitis With Pitting Edema in a Patient With Recurrent Prostate Cancer

Back to course

Pdf Summary

This case describes remitting seronegative symmetrical synovitis with pitting edema (RS3PE), a rare rheumatologic syndrome characterized by sudden onset inflammation of the small joints with prominent pitting edema of the hands and feet. It typically occurs in older adults, often those over 50, and has been associated with malignancy, including cancer patients. The cause remains uncertain, and diagnosis is primarily clinical, based on history and physical exam rather than laboratory testing.<br /><br />A 66-year-old man with a history of prostate cancer treated with resection and radiation developed six weeks of pitting edema in his hands and feet, along with difficulty flexing his fingers and toes. His primary care physician initially suspected gout and treated him with colchicine, but there was no improvement. Prednisone led to a strong initial response, but symptoms returned after treatment ended. Rheumatologic evaluation showed negative ANA, CCP, and RF tests, supporting a seronegative process. Based on the clinical picture and steroid responsiveness, RS3PE was diagnosed.<br /><br />He was started on a prolonged prednisone taper, but symptoms recurred after a missed dose. Because of his ongoing cancer and relapse of symptoms, hydroxychloroquine was added as a steroid-sparing agent to help control the disease.<br /><br />The case highlights that RS3PE, though rare, should be considered in the differential diagnosis of polyarthritis or pitting edema, especially in patients with active or recurrent cancer. While many patients respond well to low-dose prednisone, those with persistent malignancy may require longer treatment or additional immunomodulatory therapy.

Asset Subtitle

Juliana Lopez

Meta Tag

Author List Juliana Lopez

Category Clinical Vignettes

Concept RS3PE

Concept Synovitis

Concept Pitting Edema

Concept Malignancy

Concept Hand

Distinguished Non-Finalist

Presenter Organization St. Lukes University Health Network

Presenting Author Juliana Lopez

Track Adult

Keywords

RS3PE

remitting seronegative symmetrical synovitis

pitting edema

polyarthritis

seronegative

older adults

prostate cancer

prednisone

hydroxychloroquine

rheumatologic syndrome

RS3PE

Synovitis

Pitting Edema

Malignancy

Hand