Internal Medicine, Hospital Pedro Hispano, Matosinhos, Portugal
Internal Medicine, Hospital Pedro Hispano, Matosinhos, Portugal.
BMJ Case Rep. 2024 Mar 15;17(3):e257645. doi: 10.1136/bcr-2023-257645.
We present the case of an elderly man with a small-joint polyarthritis, accompanied by pitting oedema, involving hands and feet, raising clinical suspicion of remitting seronegative symmetrical synovitis with pitting oedema (RS3PE). Treatment with corticosteroids was initiated with significant improvement, but unacceptable iatrogeny ensued, and tapering was not possible without disease flare-up. A trial of tocilizumab allowed disease activity control, slow weaning of corticosteroids and, ultimately, its suspension. RS3PE is a rare rheumatological entity, initially thought to be a variant of rheumatoid arthritis (RA), with shared traits with polymyalgia rheumatica (PMR), and other seronegative spondyloarthropathies, thereby implying a shared pathophysiological background. Elevated levels of interleukin 6 (IL-6) are found in patients with RA, have shown to mirror disease activity in PMR and have also been described in the serum and synovial fluid of patients with RS3PE. Tocilizumab, an anti-IL-6 receptor antibody, shows auspicious results in several other rare rheumatic diseases other than RA.
我们报告了一例老年男性小关节多关节炎，伴有凹陷性水肿，累及手和脚，临床怀疑为缓解性血清阴性对称性滑膜炎伴凹陷性水肿（RS3PE）。开始用皮质类固醇治疗后显著改善，但随之而来的是不可接受的医源性疾病，在不出现疾病发作的情况下逐渐减少剂量是不可能的。曲妥珠单抗治疗试验允许控制疾病活动，缓慢减少皮质类固醇的用量，最终停止使用。RS3PE 是一种罕见的风湿性疾病，最初被认为是类风湿关节炎（RA）的一种变体，与风湿性多肌痛（PMR）和其他血清阴性脊柱关节病有共同特征，因此暗示其具有共同的病理生理背景。在 RA 患者中发现白细胞介素 6（IL-6）水平升高，已证明与 PMR 中的疾病活动相吻合，也在 RS3PE 患者的血清和滑膜液中描述过。托珠单抗是一种抗白细胞介素 6 受体抗体，在除 RA 以外的几种罕见风湿性疾病中显示出良好的效果。
