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Document Details :
Title: Een bejaarde man met “bokshandschoenhanden”
Author(s): DAPPER I, PEETERMANS WE, KNOCKAERT DC
Journal: Tijdschrift voor Geneeskunde
Volume: 61 Issue: 19 Date: 2005
An old man with acute symmetrical edema of the hands
We describe the case of a 71-year-old man who presented with acute symmetrical edema of the hands, not responding to a treatment with NSAID and colchicine. The clinical presentation, the negative rheumatoid factor, the absence of radiographic joint destruction and the good clinical response to treatment with corticosteroids are suggestive for the diagnosis of remitting seronegative symmetrical synovitis with pitting edema (RS3PE). This syndrome mainly affects the elderly. The major differential diagnoses are rheumatoid arthritis and polymyalgia rheumatica but other causes of edema, such as psoriatic arthritis, Reiter syndrome, mixed connective tissue disease, chondrocalcinosis, reflex sympathethic dystrophy and amyloidosis should also be excluded.
The cause is not known and this idiopathic group of patients has an excellent prognosis. Recently, cases of RS3PE associated with malignancy are described, so RS3PE may be a paraneoplastic phenomenon. There are also cases reported of patients with RS3PE who developed rheumatoid arthritis or polymyalgia rheumatica. Characteristic for these two groups are the presence of systemic complaints, resistance to low doses of corticosteroids and relapse after interruption of treatment. To differentiate between the idiopathic, paraneoplastic and the group who develop rheumatoid arthritis or polymyalgia rheumatica, long-term follow up is necessary.