Monitoring of therapeutic efficacy in a patient with RS₃PE syndrome by serologic variables and radiographic methods.
We describe a typical case of a patient with remitting seronegative symmetrical synovitis and pitting edema (RS(3)PE) syndrome. He underwent a successful clinical course monitored by serologic variables and radiographic methods. Serum levels of interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), matrix metalloproteinase-3 and serum amyloid A were remarkably elevated. Accumulation of inflammatory cells into the multiple joints was found by gallium-67 scintigraphy. Multiple and symmetrical tenosynovitis with hypervascularity in the presence of subcutaneous edema of the hands and feet were determined by magnetic resonance imaging (MRI) and ultrasonography. These serologic and radiographic abnormalities immediately improved after treatment with a low-dose steroid. Our present case supports a previous observation that synovial tissue is a major inflammatory source of RS(3)PE syndrome. IL-6 (and VEGF), probably produced from the synovial tissues, are considered to be essential factors in the development of RS(3)PE syndrome.
Kawashiri
Shin-ya
SY
Unit of Translational Medicine, Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. shinya22@nagasaki-u.ac.jp
Nakano
Michiko
M
Kawakami
Atsushi
A
Eguchi
Katsumi
K
D001774:Blood Chemical Analysis / Q000379:methods; D016903:Drug Monitoring / Q000379:methods*; D004487:Edema / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D005710:Gallium Radioisotopes; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007596:Joints / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D019278:Matrix Metalloproteinase 3 / Q000097:blood; D011239:Prednisolone / Q000627:therapeutic use*; D011877:Radionuclide Imaging / Q000379:methods; D000685:Serum Amyloid A Protein / Q000032:analysis; D040521:Subcutaneous Tissue; D013577:Syndrome; D013585:Synovitis / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D014463:Ultrasonography; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
D005710:Gallium Radioisotopes; C508600:IL6 protein, human; D015850:Interleukin-6; D000685:Serum Amyloid A Protein; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D011239:Prednisolone; D019278:Matrix Metalloproteinase 3