Remitting seronegative symmetrical synovitis with pitting oedema associated with rifampicin

Smyth, Duncan; Rehman, Rafey; Remund, Kaspar; Egan, Jim

doi:10.1007/s11845-009-0348-y

Cited by 9 publications

(7 citation statements)

References 5 publications

(7 reference statements)

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“…In the years since the first description by McCarthy et al , there have been several descriptions of RS3PE associations including neoplasm,8 9 solid and haematological tumours9 10 and also inflammatory disorders,9 11 12 infections9 13 14 and even stroke 15…”

Section: Discussionmentioning

confidence: 99%

Lucky to meet RS3PE

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Lucky to meet RS3PE

et al. 2013

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“…These rheumatic conditions are systemic lupus erythematosus [40], gout [41], Sjogren's syndrome [42], polyarteritis nodosa [43], ankylosing spondylitis [44], sarcoidosis [45], amyloidosis [46], relapsing polychondritis [27], and bronchiolitis obliterans organizing pneumonia [47]. In addition, other medical conditions or drugs associated with RS3PE include diabetes mellitus [48], dipeptidyl peptidase-4 inhibitors [49], rifampin [50], and insulin therapy [51]. RS3PE may be associated with infection, such as bacillus Calmette-Guerin (BCG) [52], parvovirus [53], and Streptobacillus moniliformis infection [54].…”

Section: Rs3pe Is Associated With Diseases and Medications Other Thanmentioning

confidence: 99%

RS3PE: Clinical and Research Development

Altman

Yao

2015

Curr Rheumatol Rep

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Remitting seronegative symmetrical synovitis with pitting edema or RS3PE is a rare elderly-onset rheumatic syndrome. Although there are overlapping clinical manifestations between RS3PE, elderly-onset rheumatoid arthritis, and polymyalgia rheumatica, RS3PE has distinct characteristics. RS3PE can be associated with neoplasia and various rheumatic conditions, suggesting that it may be heterogeneous, and is considered as a paraneoplastic rheumatic disease. The pathogenesis of RS3PE may involve vascular endothelial growth factor and infection in RS3PE based upon limited data. Patients with RS3PE without concomitant malignancy respond well to small doses of glucocorticoids and carry good prognosis.

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“…Medication-induced RS3PE is uncommon but drugs including insulin, rifampicin, and dipeptidyl peptidase-4 inhibitors have been associated with RS3PE [31][32][33]. Recently a case of an 80-year-old man with stage IV BRAF wild type melanoma treated with nivolumab who developed signs and symptoms consistent with RS3PE after the initiation of nivolumab was reported [16].…”

Section: Discussionmentioning

confidence: 99%

Nivolumab induced remitting seronegative symmetrical synovitis with pitting edema in a patient with melanoma: a case report

et al. 2018

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Background: Novel immune checkpoint inhibitors have been often utilized for different types of malignancies as salvage therapy with varying success. One obstacle to immune checkpoint inhibitor use is the higher incidence of immune-mediated side effects that can prompt discontinuation of therapy. Remitting seronegative symmetrical synovitis with pitting edema has been described with immune checkpoint inhibitors only once previously. We report a case of a patient who developed remitting seronegative symmetrical synovitis with pitting edema related to immune checkpoint inhibitor therapy and stress that these symptoms can be managed without cessation of immune checkpoint inhibitor therapy. Case presentation: We present a 70-year-old white man who presented with 4 months of progressive inflammatory arthritis with pitting edema. He had been started on nivolumab therapy for his metastatic melanoma with excellent response prior to symptom onset. The symptoms started in his knees and subsequently involved both hands and feet. On evaluation, he was wheelchair bound and completely dependent for all activities of daily living. Evaluation revealed negative serological testing and plain film imaging. Ultrasound demonstrated diffuse flexor tenosynovitis and soft tissue swelling, and a diagnosis of remitting seronegative symmetrical synovitis with pitting edema was made. He was treated with orally administered corticosteroids (0.5 mg/kg per day) which improved his symptoms significantly and allowed him to regain prior independent functioning. His corticosteroids were tapered (0.15 mg/kg per day) but not discontinued and his nivolumab treatment was not interrupted. In follow up he continued to have stable control of his melanoma as well as his remitting seronegative symmetrical synovitis with pitting edema. Conclusions: In conclusion we present the first case of nivolumab-induced remitting seronegative symmetrical synovitis with pitting edema that is controlled by maintenance low-dose orally administered corticosteroids allowing for continuation of nivolumab therapy. Clinicians who encounter mild-to-moderate immune checkpoint inhibitor immune-mediated adverse effects can consider maintaining immune checkpoint inhibitor therapy with concomitant low-dose corticosteroids rather than abrupt cessation of the immune checkpoint inhibitor.

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Remitting seronegative symmetrical synovitis with pitting oedema associated with rifampicin

Abstract: This case demonstrates a possible direct aetiological link between rifampicin and RS3PE.

Cited by 9 publications

References 5 publications

Lucky to meet RS3PE

Lucky to meet RS3PE

RS3PE: Clinical and Research Development

Nivolumab induced remitting seronegative symmetrical synovitis with pitting edema in a patient with melanoma: a case report

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