Center for Primary Care and Public Health (Unisanté), University Center of General Medicine and Public Health, University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland.
Rheumatology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
J Med Case Rep. 2022 Aug 27;16(1):334. doi: 10.1186/s13256-022-03535-z.
Remitting seronegative symmetrical synovitis with pitting edema is a rare rheumatic condition of the elderly population that is well described but whose mechanisms remain little studied. This syndrome is characterized by symmetrical swelling located mainly on the dorsal part of the hands and the feet. Because of possible heterogeneous clinical presentation, it can easily mimic the onset of other rheumatic diseases or appear associated with them. Here we report a case of a patient who developed remitting seronegative symmetrical synovitis with pitting edema with preexisting shoulder and hip girdle pain associated with progressive fatigue, indicating a possible differential diagnosis of polymyalgia rheumatica. We reviewed and compared classification for remitting seronegative symmetrical synovitis with pitting edema and polymyalgia rheumatica and discussed other differential diagnoses.
An 84-year-old Caucasian woman presented to our General Medicine Unit with acute onset of symmetrical hands and feet edema, leading to functional limitation due to pain and stiffness. Additionally, she was complaining about neck, shoulder, and pelvic girdle pain present for about 2 months associated with worsening asthenia. Blood tests showed an elevated level of C-reactive protein and erythrocyte sedimentation rate, as well as absence of anti-cyclic citrullinated peptide antibodies and rheumatoid factor. As all criteria of remitting seronegative symmetrical synovitis with pitting edema syndrome were present, the patient was treated with low-dose prednisone, with a rapid and complete resolution of symptoms. She remains asymptomatic without treatment 2 years after the onset of symptoms, without any evident oncologic etiology.
This case is an example of a classic representation of remitting seronegative symmetrical synovitis with pitting edema syndrome with clinical elements suggesting a concomitant existing early stage of polymyalgia rheumatica. These two entities, classified in the group of seronegative arthritis, can coexist (up to 10% of cases), with remitting seronegative symmetrical synovitis with pitting edema appearing as an initial or late manifestation of polymyalgia rheumatica. It is essential to remind that remitting seronegative symmetrical synovitis with pitting edema is associated with a higher risk of cancer (30%). A proper diagnosis allows the clinician to precisely define the appropriate therapy duration to limit its side effects in the elderly and remain aware of the potential risk of underlying malignancy.
缓解型血清阴性对称性滑膜炎伴凹陷性水肿是一种罕见的老年人群风湿性疾病，其特征为主要位于手背和足部的对称性肿胀。由于可能存在异质性临床表现，这种疾病很容易被误诊为其他风湿性疾病或与其他风湿性疾病同时出现。我们在此报告一例缓解型血清阴性对称性滑膜炎伴凹陷性水肿患者，该患者同时存在先前存在的肩部和髋部带疼痛，并伴有进行性疲劳，这表明可能需要对巨细胞动脉炎进行鉴别诊断。我们回顾并比较了缓解型血清阴性对称性滑膜炎伴凹陷性水肿和巨细胞动脉炎的分类，并讨论了其他鉴别诊断。
一位 84 岁白人女性因手部和脚部对称性急性水肿导致功能受限而出现疼痛和僵硬，随后到我们的综合医学科就诊。此外，她还抱怨大约 2 个月前颈部、肩部和骨盆带疼痛，并伴有进行性疲劳。血液检查显示 C 反应蛋白和红细胞沉降率升高，且抗环瓜氨酸肽抗体和类风湿因子阴性。由于缓解型血清阴性对称性滑膜炎伴凹陷性水肿综合征的所有标准均存在，因此给予该患者低剂量泼尼松治疗，其症状迅速完全缓解。症状发作 2 年后，患者无症状且无需治疗，也未发现明显的肿瘤病因。
该病例是缓解型血清阴性对称性滑膜炎伴凹陷性水肿综合征的典型表现，其临床特征提示同时存在巨细胞动脉炎的早期阶段。这两种疾病都被归类为血清阴性关节炎，可能同时存在（高达 10%的病例），缓解型血清阴性对称性滑膜炎伴凹陷性水肿可作为巨细胞动脉炎的初始或晚期表现。重要的是要提醒的是，缓解型血清阴性对称性滑膜炎伴凹陷性水肿与癌症风险增加（30%）相关。正确的诊断可以使临床医生准确确定适当的治疗持续时间，以限制其在老年人中的副作用，并保持对潜在恶性肿瘤的潜在风险的认识。
