Grand Rounds Vol 10 pages 71–73 Specialities: Rheumatology Article Type: Case Report DOI: 10.1102/1470-5206.2010.0015 ß 2010 e-MED Ltd Remitting seronegative symmetrical synovitis with pitting oedema Anna J. Hartley, Jessica Manson and Ali S.M. Jawad Rheumatology Department, The Royal London Hospital, London, E1 4DG, UK Corresponding address: Anna J. Hartley, Rheumatology Department, Mile End Hospital, Bancroft Road, London, E1 4DG, UK. Email: [email protected]Date accepted for publication 16 August 2010 Abstract Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) is a rare rheumatologic condition frequently missed but easily treated. We describe a case of RS3PE and explore the literature surrounding this arthritis. Keywords RS3PE; peripheral oedema; synovitis; rheumatology. Introduction Acute swelling of the hands and feet with pitting oedema can present to various specialities. It rarely presents directly to the rheumatologists but often to the admitting physicians, care of the elderly or, when complicated by carpal tunnel syndrome, to the orthopaedic surgeons. Cases of remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) are probably more common than documented but under or misdiagnosed. We describe a case of RS3PE presenting via the orthopaedic surgeons. Case report A sixty year old HGV driver presented to the orthopaedic surgeons with an 18-month history of carpal tunnel symptoms in his left hand. He had a past medical history of ischaemic heart disease and bilateral knee replacements. He was mainly on cardiac medications. At this initial assessment, he was found to have numbness of his left index and middle finger, but his hands were otherwise normal. He was listed for elective carpal tunnel decompression. Over the following weeks, he developed bilaterally painful and swollen hands. No other joints were affected and he felt otherwise well. He had had no recent infections, nor any history of psoriasis or inflammatory bowel disease. On examination his hands were red, diffusely swollen and tender with synovitis of the joints and pitting oedema over the dorsal aspects. The acute swelling had caused cracking of the skin (Fig. 1). Distal pulses were present and capillary refill was less than 2 seconds in all fingers, but his hands were cool. Sensation was normal but movement was limited because of the swelling This paper is available online at http://www.grandrounds-e-med.com. In the event of a change in the URL address, please use the DOI provided to locate the paper.
3
Embed
Remitting seronegative symmetrical synovitis with … · Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) is a rare rheumatologic ... [7]. However, cases of
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Grand Rounds Vol 10 pages 71–73
Specialities: Rheumatology
Article Type: Case Report
DOI: 10.1102/1470-5206.2010.0015
� 2010 e-MED Ltd
Remitting seronegative symmetrical
synovitis with pitting oedema
Anna J. Hartley, Jessica Manson and Ali S.M. Jawad
Rheumatology Department, The Royal London Hospital, London, E1 4DG, UK
Corresponding address: Anna J. Hartley, Rheumatology Department,
Mile End Hospital, Bancroft Road, London, E1 4DG, UK.