Carpal tunnel syndrome caused by remitting seronegative symmetrical synovitis with pitting oedema.

Britta Nijsse, Gerwin Roks - Department of Neurology,

St Elisabeth Hospital, Tilburg, The Netherlands

Correspondence to: Britta Nijsse, b.nijsse@

elisabeth.nl

To cite: Nijsse B, Roks G.

BMJ Case Reports Published online: 28 November 2012

DESCRIPTION

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.

Learning points:

▸ 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

be considered.

▸ Given the presumed paraneoplastic aetiology,

it is important to screen for associated

malignancies.

▸ RS3PE has an excellent response on

glucocorticoids and also the CTS symptoms

resolve.

Competing interests None.

Patient consent Obtained.

REFERENCES

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

1997;24:333–6.

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.

2007;82:1510–15.

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

Casereports