Emamifar Amir, Hess Soeren, Gildberg-Mortensen Rannveig, Jensen Hansen Inger Marie
Department of Rheumatology, University Hospital of Odense, Svendborg Hospital, Svendborg, Denmark.
Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
Am J Case Rep. 2016 Feb 3;17:60-4. doi: 10.12659/ajcr.895717.
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare condition that occurs in elderly individuals. It can present alone or in association with various rheumatic or malignant diseases.
An 83-year-old man presented with anemia, hyper-sedimentation, and pitting edema of the back of the hands. The patient complained of pain and stiffness of the shoulder and hip girdles, especially in the morning. He was previously diagnosed with adenocarcinoma of the prostate. After 3 years of watchful waiting, treatment with goserelin, a gonadotropin releasing hormone agonist, was started, when PSA had increased to 67.9 µg/l. About 1 year before the cancer treatment, the patient also presented with sore and swollen hands, compatible with RS3PE, which remitted after a few months of prostatic cancer treatment. Thorough laboratory evaluation was performed upon admission to the Rheumatology Department and he was referred for FDG PET/CT on suspicion of metastases of the previously diagnosed prostatic cancer. PET/CT imaging revealed increased FDG uptake in the soft tissues around the shoulders and hips, but no evidence of bone metastasis or other malignant findings. A diagnosis of polymyalgia rheumatica (PMR) together with RS3PE syndrome was made and treatment with prednisolone 15 mg/d was started, which resulted in rapid resolution of the symptoms.
Presence of RS3PE in relation with PMR and prostatic cancer in our patient suggests a common trigger factor. To the best of our knowledge, this is the first report of a case of RS3PE that presented twice with 2 different diagnoses in the same patient.
缓解性血清阴性对称性滑膜炎伴凹陷性水肿（RS3PE）是一种发生于老年人的罕见病症。它可单独出现或与各种风湿性或恶性疾病相关。
一名83岁男性出现贫血、血沉加快以及手背凹陷性水肿。患者主诉肩带和髋带疼痛及僵硬，尤其是在早晨。他之前被诊断为前列腺腺癌。在进行了3年的密切观察等待后，当前列腺特异抗原（PSA）升至67.9μg/L时，开始使用促性腺激素释放激素激动剂戈舍瑞林进行治疗。在癌症治疗前约1年，患者还出现了手部疼痛和肿胀，符合RS3PE表现，在前列腺癌治疗数月后症状缓解。入院风湿科时进行了全面的实验室评估，因怀疑先前诊断的前列腺癌转移，他被转诊进行氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（FDG PET/CT）。PET/CT成像显示肩部和髋部周围软组织的FDG摄取增加，但无骨转移或其他恶性病变的证据。诊断为风湿性多肌痛（PMR）合并RS3PE综合征，并开始使用15mg/d泼尼松龙治疗，症状迅速缓解。
我们的患者中RS3PE与PMR和前列腺癌相关，提示存在共同的触发因素。据我们所知，这是首例同一患者两次出现不同诊断的RS3PE病例报告。
