Navigation

    Tiny Notes

    • Register
    • Login
    • Search
    • 首頁
    • Notes
    • Ask
    • Latest
    • Hot
    • Tags

    Remitting seronegative symmetrical synovitis with pitting edema

    每日 Notes
    rs3pe 水腫edema 皮膚科 風濕免疫科
    1
    1
    135
    Loading More Posts
    • Oldest to Newest
    • Newest to Oldest
    • Most Votes
    Reply
    • Reply as topic
    Log in to reply
    This topic has been deleted. Only users with topic management privileges can see it.
    • T
      TinyNotes last edited by

      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

      • 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)

      • 抽血能夠看到CRP等發炎指數升高

      • 患者不會有骨頭侵犯、不會有皮下結節;抽血RF(-)

      • 對於低劑量類固醇反應相當好,預後佳

      • 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

      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.

      1 Reply Last reply Reply Quote 0
      • First post
        Last post