What is the RS3PE syndrome?
A syndrome characterized by an acute severe onset of symmetrical synovitis of the small joints of the hands, wrists, and flexor tendon sheaths, accompanied by pitting edema of the dorsum of the hand (“boxing-glove” hand). Other joints may be involved. This syndrome affects mostly elderly (mean age, 70 years) white men (male/female ratio, 4:1).
All patients are RF-negative. Symptoms do not respond to NSAIDs but are very sensitive to low-dose prednisone and hydroxychloroquine. Bony erosions do not occur. The disease predictably remits in <36 months and, unlike RA, does not recur after withdrawal of medications. Severe pitting edema at the hands has also been reported in polymyalgia rheumatica and as a paraneoplastic syndrome. Because of this association with cancer, patients with this syndrome should be carefully evaluated for underlying malignancy.
