- 期刊
Inflammatory Polyarthritis in an 80-year-old Frail Male-A Case of Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE)
一位80歲衰弱老人的發炎性多發關節炎—緩解性血清陰性對稱型滑膜炎併壓陷性水腫症候群個案報告
摘要
一位80歲老人大約六個月前突然發生多處發炎性關節炎，使得原本健康良好的他變得病弱。衰弱的症狀包含胃口不佳、體重減輕，無法獨立起立及行走。檢查時發現，病人兩側手背腳背有壓陷性水腫，實驗室檢查發現正球性貧血，發炎指數升高（ESR 44 /hr,CRP 10.22 mg/dl），白血球數正常。自體抗體檢查、類風濕因子、抗環瓜氨酸抗體皆為陰性。雙手、踝關節及膝關節X光檢查發現軟組織水腫但無侵蝕現象。腫瘤標記正常，血中蛋白質免疫電泳檢查也正常。根據此病患的雙手壓陷性水腫、突發性多處關節炎，年紀大於50歲，類風濕因子陰性，並排除其他可能疾病後，診斷為緩解性血清陰性對稱型滑膜炎併壓陷性水腫症候群，此病患接受低劑量類固醇之後反應極佳。當老年病患罹患突發性多處關節炎及壓陷性水腫時應考慮此病。
並列摘要
Sudden onset of inflammatory polyarthritis developed about six months ago in an 80-year-old healthy male. Sick and weak due to the inflammatory polyarthritis, the patient reported frailty symptoms including poor appetite, body weight loss, and inability to walk or standup without aids. On examination, pitting edema over both dorsal hands and feet was noted. Laboratory findings indicated normochromic nomocytic anemia, raised inflammatory markers (ESR 44 /hr, CRP 10.22 mg/dl), and normal WBC while tests for autoantibodies, rheumatoid factor and anti-cyclic citrullinated protein antibody were all negative. Radiological findings of the extremities showed swollen soft tissue without any erosion. Detection of tumor markers was unremarkable, and monoclonal spike was not observed in serum protein immunoelectrophoresis. Remitting seronegative symmetrical synovitis with pitting edema syndrome (RS3PE) was diagnosed based on the findings of bilateral pitting edema of hands, sudden onset of polyarthritis, an age over 50 years old, and seronegative rheumatoid factor in this patient after excluding other possibilities. This patient showed an excellent response to low doses of corticosteroids. RS3PE should be considered for elderly male patients with acute onset of polyarthritis and pitting edema of extremities.