Kato Takashi, Ubara Yoshifumi, Sawa Naoki, Tagami Tetsuo, Katori Hideyuki, Takemoto Fumi, Hara Shigeko, Takaichi Kenmei
Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Takatsu-ku, Kawasaki, Kanagawa 213-8587.
Intern Med. 2004 Feb;43(2):143-7. doi: 10.2169/internalmedicine.43.143.
A 64-year-old Japanese woman with a two-week history of polyarthralgia and persistent cough was diagnosed as seropositive polyarthritis and fulfilled the criteria of early rheumatoid arthritis (RA). In addition, inflammatory pitting edema of the distal extremities was apparent, suggestive of the remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. A number of investigations including hand MRI, bone scintigraphy and HLA typing supported a diagnosis of RS3PE syndrome rather than RA. Chest computed tomography revealed concomitant evidence of bronchiolitis obliterans organizing pneumonia (BOOP). Treatment with 30 mg of prednisolone daily immediately ameliorated the polyarthritis and the BOOP. Seropositive polyarthritis with distal pitting edema may be categorized as both RA and the RS3PE syndrome.
一名64岁的日本女性，有两周的多关节痛和持续咳嗽病史，被诊断为血清阳性多关节炎，并符合早期类风湿关节炎（RA）的标准。此外，远端肢体出现炎性凹陷性水肿，提示为伴有凹陷性水肿的缓解型血清阴性对称性滑膜炎（RS3PE）综合征。包括手部MRI、骨闪烁显像和HLA分型在内的多项检查支持RS3PE综合征而非RA的诊断。胸部计算机断层扫描显示同时存在机化性细支气管炎伴机化性肺炎（BOOP）的证据。每日服用30毫克泼尼松龙治疗立即改善了多关节炎和BOOP。伴有远端凹陷性水肿的血清阳性多关节炎可能同时归类为RA和RS3PE综合征。
