我们介绍了一个患有小关节多关节炎的老人的病例,伴有凹陷性水肿,涉及手和脚,临床怀疑缓解血清阴性对称性滑膜炎伴凹陷性水肿(RS3PE)。皮质类固醇治疗开始显着改善,但是随之而来的是不可接受的医术,如果没有疾病发作,就不可能逐渐减少。托珠单抗的试验允许疾病活动控制,皮质类固醇的缓慢断奶,最终,它的暂停。RS3PE是一种罕见的风湿病实体,最初被认为是类风湿关节炎(RA)的一种变体,具有风湿性多肌痛(PMR)的共同特征,和其他血清阴性脊柱关节病,从而暗示共同的病理生理背景。在RA患者中发现白细胞介素6(IL-6)水平升高,已显示反映PMR中的疾病活动,并且在RS3PE患者的血清和滑液中也有描述。Tocilizumab,抗IL-6受体抗体,在除RA以外的其他几种罕见的风湿病中显示出吉祥的结果。
We present the case of an elderly man with a small-joint polyarthritis, accompanied by pitting oedema, involving hands and feet, raising clinical suspicion of remitting seronegative symmetrical synovitis with pitting oedema (RS3PE). Treatment with corticosteroids was initiated with significant improvement, but unacceptable iatrogeny ensued, and tapering was not possible without disease flare-up. A trial of tocilizumab allowed disease activity control, slow weaning of corticosteroids and, ultimately, its suspension. RS3PE is a rare rheumatological entity, initially thought to be a variant of rheumatoid arthritis (RA), with shared traits with polymyalgia rheumatica (PMR), and other seronegative spondyloarthropathies, thereby implying a shared pathophysiological background. Elevated levels of interleukin 6 (IL-6) are found in patients with RA, have shown to mirror disease activity in PMR and have also been described in the serum and synovial fluid of patients with RS3PE. Tocilizumab, an anti-IL-6 receptor antibody, shows auspicious results in several other rare rheumatic diseases other than RA.