Britta Nijsse, Gerwin Roks - Department of Neurology,
St Elisabeth Hospital, Tilburg, The Netherlands
Correspondence to: Britta Nijsse, b.nijsse@
To cite: Nijsse B, Roks G.
BMJ Case Reports Published online: 28 November 2012
A 73-year-old man presented with paresthesias of
the ﬁngertips and weakness of the abductor pollicis
brevis muscle and the opponens pollicis muscle of
both hands. Carpal tunnel syndrome (CTS) was
suspected and conﬁrmed by electromyography. The
presence of swelling and pitting oedema of both
hands (ﬁgures 1 and 2) led to the diagnosis of
remitting seronegative symmetrical synovitis with
pitting oedema (RS3PE).
RS3PE is a rheumatological clinical syndrome,
distinctive of rheumatoid arthritis and polymyalgia
rheumatica. It occurs predominantly in elderly men
and is characterised by rapid-onset symmetrical
synovitis, pitting oedema especially on the dorsum
of the hands, negative rheumatoid factor and a dramatic response to low doses of glucocorticoids (prednisone 10–20 mg/ day).
Few studies report the correlation of RS3PE with
CTS. An incidence of 22–43% is reported.
symptoms completely resolve after treating RS3PE
with steroids. Every neurologist should recognise
CTS, but this does not always relate the swollen
hands to RS3PE. Owing to the presumed paraneoplastic aetiology, it is important to recognise the syndrome. Several reports about RS3PE-associated
malignant conditions were published, mostly
adenocarcinomas or haematological malignancies.
This created the presumption of RS3PE being a
paraneoplastic manifestation. The search for occult
malignancy is particularly crucial in patients with
systemic symptoms and those who are not responsive to steroids.
The symptoms in our patient completely
resolved after steroid treatment and analysis
showed no signs of malignancy.
▸ If Carpal tunnel syndrome (CTS) goes together
with swollen hands and pitting oedema, the
diagnosis of remitting seronegative symmetrical
synovitis with pitting oedema (RS3PE) should
▸ Given the presumed paraneoplastic aetiology,
it is important to screen for associated
▸ RS3PE has an excellent response on
glucocorticoids and also the CTS symptoms
Competing interests None.
Patient consent Obtained.
1 Olive A, del Blanco J, Pons M, et al. The clinical spectrum of
remitting seronegative symmetrical synovitis with pitting edema.
The Catalan Group for the Study of RS3PE. J Rheumatology
2 Bucaloiu ID, Olenginski TP, Harrington TM. Remitting seronegative
symmetrical synovitis with pitting edema syndrome in a rural
tertiary care practice: a retrospective analysis. Mayo Clin Proc.
3 Cantini F, Salvarini C, Olivieri I, et al. Remitting seronegative
symmetrical synovitis with pitting oedema (RS3PE) syndrome: a
prospective follow up and magnetic resonance imaging study. Ann
Rheum Dis 1999;58:230–6.
Figure 1 Promine