Letter to the Editor
Diagnosis of remitting seronegative symmetrical synovitis with pitting edema in a patient with sarcoidosis: Comment on the article by Dejaco et al
Diagnosis of Remitting Seronegative Symmetrical Synovitis With Pitting Edema in a Patient With Sarcoidosis: Comment on the Article by Dejaco et al
To the Editors:
I read with interest the article by Dejaco et al (1), published in a recent issue of Arthritis Care & Research. I believe that the diagnosis of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is inappropriate for this case because it does not correspond to the description given by McCarty et al (2). RS3PE is a syndrome with various etiologies (3), but the only case of sarcoidosis that corresponds to this description is the case by Matsuda et al (4). The other published cases show a peculiar aspect of acute articular symptoms of sarcoidosis. We have observed many examples of this aspect and mention it briefly (5) because it has been previously described (6). The subsequent articles (7–9) gave the impression that this aspect was well known; however, recent articles (1, 10) seem to indicate that it is not.
I would like to emphasize the differences between this specific aspect and RS3PE syndrome. First, the edema of the ankles and feet was dark-red (1) or red as it is clearly shown in Figure 1 in the article by Cantini et al (9) and not white as it is in RS3PE syndrome. Second, the edema involved only the lower extremities. With the exception of the case by Matsuda et al, which appeared in an elderly woman without any information about kidney function (4), RS3PE syndrome is always present in the upper extremities (11). Third, this peculiar aspect was observed in young females contrary to RS3PE syndrome, which is observed, when it is primary, in elderly males. In conclusion, this peculiar aspect of remitting distal lower extremity pitting edema in Dejaco et al's patient is very suggestive of articular sarcoidosis and Lofgren's syndrome.
- 1 Remitting seronegative syndrome with pitting edema as the presenting symptom in a young, male patient with sarcoidosis: a case report. Arthritis Rheum 2008; 59: 148–52., , , , , , et al.
- 2 Remitting seronegative symmetrical synovitis with pitting edema: RS3PE syndrome. JAMA 1985; 254: 2763–7., , , .
- 3 Remitting seronegative symmetrical synovitis with pitting oedema: disease or syndrome? Ann Rheum Dis 1995; 54: 681–4., , , , , , et al.
- 4 Sarcoidosis with high serum levels of vascular endothelial growth factor (VEGF), showing RS3PE-like symptoms in extremities. Clin Rheumatol 2004; 23: 246–8., , , , , , et al.
- 5 Comparison of the manifestations of acute sarcoid arthritis with and without erythema nodosum: immunopathogenic significance. Scand J Rheumatol 1982; 11: 13–6., , , , .
- 6 Periarticular inflammation, bilateral hilar adenopathy and a sarcoid reaction. Arthritis Rheum 1970; 13: 101–11., , .
- 7 Arthritis, hilar adenopathy, erythema nodosum complex. J Rheumatol 1982; 9: 935–8., .
- 8 Periarticular ankle sarcoidosis: a variant of Lofgren's syndrome. J Rheumatol 1996; 23: 874–7., , , , , .
- 9 Remitting distal lower extremity swelling with pitting oedema in acute sarcoidosis [letter]. Ann Rheum Dis 1997; 56: 565–6., , , , , , et al.
- 10 Case records of the Massachusetts General Hospital: case 4-2001. N Engl J Med 2001; 344: 443–9., .
- 11 Catalán Group for the Study of RS3PE. The clinical spectrum of remitting seronegative symmetrical synovitis with pitting edema. J Rheumatol 1997; 24: 333–6., , , , , and the
Paul Le Goff Professor*, * Brest Cedex, France.