Remitting seronegative symmetrical synovitis with pitting edema
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簡介
Remitting seronegative symmetrical synovitis with pitting edema,簡稱RS3PE,是個晚發性的風濕疾病,特徵是突發性的雙側肢體水腫,且對於類固醇反應良好
流行病學
- 主要出現在老年族群(尤其大於60歲)
- 男性較多(男女比約2:1)
- 發生率:0.09%
臨床表現
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對稱性的腱鞘炎(tenosynovitis),主要在上肢出現;且合併急性發作的pitting edema(主要在手背出現);發作時可能合併系統性症狀(如發燒)
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抽血能夠看到CRP等發炎指數升高
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患者不會有骨頭侵犯、不會有皮下結節;抽血RF(-)
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對於低劑量類固醇反應相當好,預後佳
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部分患者可能和其他系統性疾病/藥物/惡性腫瘤有關
- 惡性腫瘤
約20%合併惡性腫瘤;可能是實體腫瘤或血液腫瘤
至於cancer survey要做到多少程度,尚未有定論
若為惡性腫瘤相關的RS3PE,通常對類固醇反應較不好 - 風濕免疫疾病:SLE、Sjogren’s syndrome
- 感染:parvovirus、stenotrophomonas
- 藥物:DPP4 inhibitor、immune checkpoint inhibitor等
- 惡性腫瘤
病生理機轉
- VEGF可能在病生理機轉中扮演角色,有研究發現RS3PE的患者血中VEGF升高,且在治療後level會下降
- VEGF具有血管舒張的效果,且能提高血管的通透性
治療
- 若為原因不明的RS3PE,通常對低劑量類固醇反應非常好
- 若為惡性腫瘤相關的RS3PE,對於類固醇反應較差,且需要先治療腫瘤
References
• Yajima, Shugo, et al. "Paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE), improved following surgical resection of prostatic carcinoma: A case report." Urology Case Reports 32 (2020): 101232.
• Hassan, Haswadi F., and Richard Conway. "Image of the month: Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE): An important spot diagnosis." Clinical Medicine 20.5 (2020): 524.
• Li, Hongbin, Roy D. Altman, and Qingping Yao. "RS3PE: clinical and research development." Current rheumatology reports 17.8 (2015): 1-6.
• Gauci, Marie-Léa, et al. "Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome induced by nivolumab." Seminars in arthritis and rheumatism. Vol. 47. No. 2. WB Saunders, 2017.