Remitting distal lower extremity swelling with pitting oedema in acute sarcoidosis

Cantini, Fabrizio; Niccoli, Laura; Olivieri, Ignazio; Barozzi, Libero; Pavlica, Pietro; Bozza, A.; Macchioni, P; Padula, Angela; Salvarani, Carlo

doi:10.1136/ard.56.9.565

Cited by 28 publications

(21 citation statements)

References 7 publications

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“…lymphoma, chronic lymphocytic leukaemia, myelodysplastic syndrome, prostatic, gastric, colic, endometrial, hepatocellular and pancreatic carcinoma. In rare circumstances RS 3 PE could be an indication of sarcoidosis or vasculitis, as in periarteritis nodosa or Horton's disease [2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Remitting Seronegative Symmetrical Synovitis with Pitting Oedema: A Study of 12 Cases

Paira¹,

Graf²,

Roverano³

et al. 2002

Clin Rheumatol

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Twelve patients with remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) were analysed. Eight of them had typical RS3PE without underlying disease, and four presented associated neoplasia. The first patients experienced an excellent response to low doses of prednisone, and they all achieved complete and permanent remission. The mean treatment duration was 18 months and the mean follow-up was 4.4 years. During the follow-up, none of these patients relapsed, had fever or general health deterioration, and hand and foot radiographs did not show erosion. One of them developed a panarteritis nodosa 6 years later. Four RS3PE patients had associated neoplasia. Two were with solid malignancies, and the other two presented haematological malignancies. In one of them RS3PE preceded the diagnosis of malignancy. The diagnosis of RS3PE in the other patients was subsequent to cancer. The first patients presented clinical characteristics suggestive of paraneoplastic RS3PE, and they had a poor response to corticosteroid therapy. Two patients died, and the rest of them had a complete response to surgical resection of the tumour or to chemotherapy. In general, idiopathic RS3PE patients do not show either general health deterioration or fever and they do respond to low doses of steroids (10 mg/day). We observed strong contrasts with the results obtained when treating RS3PE patients with associated neoplasia. In patients with RS3PE the presence of systemic symptoms along with resistance to low doses of corticosteroid therapy should alert the physician to the possible presence of malignancy.

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Section: Discussionmentioning

confidence: 99%

Remitting Seronegative Symmetrical Synovitis with Pitting Oedema: A Study of 12 Cases

Paira¹,

Graf²,

Roverano³

et al. 2002

Clin Rheumatol

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“…These symptoms differ from patients with rheumatoid arthritis (RA) but occur among patients with other diseases within the SpA group. Other manifestations in patients with PsA include uveitis [11,12] distal extremity swelling with pitting oedema [13], possibly because of lymphatic obstruction [14], and discoloration of the skin over affected joints [15]. As yet neither psoriasis nor PsA have been described as a disease with systemic manifestations.…”

Section: Introductionmentioning

confidence: 99%

Psoriatic Arthritis-New Insights Give New Options for Treatment

Alenius

2007

CMC

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Psoriatic arthritis (PsA), an inflammatory joint disease associated with psoriasis of the skin, has a heterogeneous pattern expressed by different manifestations, such as mild mono-oligoarthritis, a very severe, erosive and destructive polyarthritis indistinguishable from rheumatoid arthritis, and spondylarthropathy with axial involvement or enthesitis. The disease pattern often differs between patients as well as within the same patient over time. Measurable inflammatory activity is not always evident. Early detection of inflamed joints or axial involvement in patients with PsA is important in order to reduce the inflammation and prevent destruction, deformity and functional disability in the joints involved. Several factors, e.g., genetic, immunological, environmental and vascular, have been proposed to be of importance for the aetiology, the expression and prognosis of PsA. The basic treatment for PsA has been administration of non-steroid anti-inflammatory drugs (NSAIDs). Few disease modifying anti-rheumatic drugs (DMARDs) have been available due to a lack of efficacy of most of the DMARDs used for other rheumatic diseases. New insights into genetic, immunological and vascular factors in PsA are of interest as possible targets for future therapy and will be discussed in this review.

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“…In 1985, McCarty et al [11] observed ten patients aVected by remitting seronegative symmetrical synovitis with pitting oedema of the upper and/or lower limbs (RS3PE syndrome), which was considered to be secondary to vigorous tenosynovitis and synovitis of the underlying joints [9]. The clinical Wndings of RS3PE syndrome have also been observed in other rheumatic diseases such as polymyalgia rheumatica, giant cell arteritis, ankylosing spondylitis, late-onset undiVerentiated spondyloarthropathies and acute sarcoidosis [9,[12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Two cases of distal extremity swelling with pitting oedema in psoriatic arthritis: the different pathological mechanisms

et al. 2009

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In psoriatic arthritis, swelling and pitting oedema may be caused by diVerent pathogenic mechanisms: on one hand, the involvement of tenosynovial structures; on the other hand, the involvement of lymphatic vessels, which may be rarely implicated by the inXammatory process. This diVerent involvement is responsible for a diVerent response to therapy and a diVerent clinical outcome. In fact, patients with inXammation of the tenosynovial structures and normal lymphatic drainage have a more favourable clinical outcome and response to pharmacologic treatment, whilst patients aVected by psoriatic arthritis with chronic lymphatic vascular damage are characterized usually by resistance of oedema to therapy. In this study, we report two cases of psoriatic arthritis with distal extremity swelling and pitting oedema. In the Wrst patient, the swelling and pitting oedema were associated with lymphatic obstruction, as detected by lymphoscintigraphy. In the second, the predominant involvement of the tenosynovial structures, as shown by magnetic resonance, with normal lymphatic Xow, may have been the cause of arthritis with oedema. These diVerent pathogenetic mechanisms were associated with diVerent response to therapy. Nevertheless, oedema was resistant to therapy in both patients probably because of other unknown factors, which inXuence therapy and clinical outcome.

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Remitting distal lower extremity swelling with pitting oedema in acute sarcoidosis

Cited by 28 publications

References 7 publications

Remitting Seronegative Symmetrical Synovitis with Pitting Oedema: A Study of 12 Cases

Remitting Seronegative Symmetrical Synovitis with Pitting Oedema: A Study of 12 Cases

Psoriatic Arthritis-New Insights Give New Options for Treatment

Two cases of distal extremity swelling with pitting oedema in psoriatic arthritis: the different pathological mechanisms

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