Cantini F, Salvarani C, Olivieri I, Barozzi L, Macchioni L, Niccoli L, Padula A, Pavlica P, Boiardi L
Unità Reumatologica, 2nd Divisione di Medicina, Ospedale di Prato, Italy.
Ann Rheum Dis. 1999 Apr;58(4):230-6. doi: 10.1136/ard.58.4.230.
To determine the clinical characteristics of patients with "pure" remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome, and to investigate its relation with polymyalgia rheumatica (PMR). Magnetic resonance imaging (MRI) was used to describe the anatomical structures affected by inflammation in pure RS3PE syndrome.
A prospective follow up study of 23 consecutive patients with pure RS3PE syndrome and 177 consecutive patients with PMR diagnosed over a five year period in two Italian secondary referral centres of rheumatology. Hands or feet MRI, or both, was performed at diagnosis in 7 of 23 patients.
At inspection evidence of hand and/or foot tenosynovitis was present in all the 23 patients with pure RS3PE syndrome. Twenty one (12%) patients with PMR associated distal extremity swelling with pitting oedema. No significant differences in the sex, age at onset of disease, acute phase reactant values at diagnosis, frequency of peripheral synovitis and carpal tunnel syndrome and frequency of HLA-B7 antigen were present between patients with pure RS3PE and PMR. In both conditions no patient under 50 was observed, the disease frequency increased significantly with age and the highest frequency was present in the age group 70-79 years. Clinical symptoms for both conditions responded promptly to corticosteroids and no patient developed rheumatoid arthritis during the follow up. However, the patients with pure RS3PE syndrome were characterised by shorter duration of treatment, lower cumulative corticosteroid dose and lower frequency of systemic signs/symptoms and relapse/recurrence. Hands and feet MRI showed evidence of tenosynovitis in five patients and joint synovitis in three patients.
The similarities of demographic, clinical, and MRI findings between RS3PE syndrome and PMR and the concurrence of the two syndromes suggest that these conditions may be part of the same disease and that the diagnostic labels of PMR and RS3PE syndrome may not indicate a real difference. The presence of distal oedema seems to indicate a better prognosis.
确定伴有凹陷性水肿的“纯”缓解型血清阴性对称性滑膜炎（RS3PE）综合征患者的临床特征，并研究其与风湿性多肌痛（PMR）的关系。采用磁共振成像（MRI）描述纯RS3PE综合征中受炎症影响的解剖结构。
在意大利的两个二级风湿病转诊中心，对连续23例纯RS3PE综合征患者和连续177例在五年期间诊断为PMR的患者进行前瞻性随访研究。23例患者中有7例在诊断时进行了手部或足部MRI检查，或两者均进行了检查。
在所有23例纯RS3PE综合征患者中，均发现手部和/或足部腱鞘炎的证据。21例（12%）PMR患者伴有远端肢体肿胀和凹陷性水肿。纯RS3PE患者与PMR患者在性别、发病年龄、诊断时的急性期反应物值、外周滑膜炎和腕管综合征的发生率以及HLA - B7抗原的发生率方面无显著差异。在这两种情况下，均未观察到50岁以下的患者，疾病发生率随年龄显著增加，最高发生率出现在70 - 79岁年龄组。两种疾病的临床症状对皮质类固醇均有迅速反应，随访期间无患者发展为类风湿关节炎。然而，纯RS3PE综合征患者的特点是治疗持续时间较短、累积皮质类固醇剂量较低以及全身体征/症状和复发/再发的频率较低。手部和足部MRI显示5例患者有腱鞘炎证据，3例患者有关节滑膜炎证据。
RS3PE综合征和PMR在人口统计学、临床和MRI表现上的相似性以及两种综合征的并存表明，这些情况可能是同一疾病的一部分，PMR和RS3PE综合征的诊断标签可能并不表明真正的差异。远端水肿的存在似乎预示着较好的预后。
