RS3PE Syndrome- Orthobiological Therapy

   

Licinio Carneiro^*

Received: March 28, 2022 | Published: April 15, 2022

Copyright^© 2022 genesis pub by Carneiro L. CC BY-NC-ND 4.0 DEED. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License., This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.

DOI:  https://doi.org/10.52793/JSCR.2022.3(2)-32

 

Abstract

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare rheumatologic disease of the elderly characterized by joint pain in the hands and wrists, with pitting edema and tenosynovitis of the tendinous structures of the wrist and hand and may, however, extend to other joint locations with a favorable response to glucocorticoids. We describe the case of a patient diagnosed with the RS3PE entity and followed up in a Physiatry consultation, in which a treatment with activated platelet-rich plasma according to the GOLDIC ® method was proposed, with very positive results that remained after 12 months of treatment.

Keywords

RS3PE; Peripheral polyarthritis; GOLD.

Introduction

Although it was originally known as “benign rheumatoid arthritis of the elderly”, it was not until 1985, when McCarty et al. carried out a cohort study of several patients of advanced age, RS3PE was then described as a different clinical entity from seronegative rheumatoid arthritis (RA) that occurs predominantly in men over 60 years of age (2/3) with a higher incidence in Caucasians and in the rural population.

Although there are overlapping clinical manifestations between RS3PE, rheumatoid arthritis, and polymyalgia rheumatica, RS3PE has distinct features with the following classification criteria: bilateral swelling of both hands, sudden onset of polyarthritis, age over 50 years, and rheumatoid factor (RF) seronegative. It is characterized by symmetrical polyarthritis with synovitis of the extensor and flexor tendons, severe edema with depression on the dorsum of the hands, and weakness of the pelvic and scapular girdles.

Although the cause is still unclear, RS3PE can occur in association with infectious microorganisms, various rheumatic diseases, paraneoplastic syndromes and therapy with certain drugs. The pathogenesis of RS3PE may underlie changes in vascular endothelial growth factor, interleukin-6 and infection, observed in studies based on limited data from RS3PE. The fundamental therapeutic factor, in patients with RS3PE without concomitant malignancy, is the good response to small doses of glucocorticoids, although temporary.

Clinical Case

In the present case, we present a 67-year-old female patient, Caucasian, residing in a city, with the professional occupation of manager/entrepreneur.

She started insidiously for 6 years a clinical picture of polyarthralgia, with polyarthritis of the upper limbs involving the left shoulder, both hands, wrists and both feet, predominantly on the left.

Observed several times in a period of crisis, the painful involvement compromised joint functionality, with swelling due to synovitis but without a permanent “deficit”: functional impotence, swelling in the back and fingers of both hands, with pain on palpation in the radio-articular joints. carpicas, carpo-metacarpicas, metacarpophalangeal and interphalangeal, in the paths of the extensor tendons (Figure1).