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Remitting, seronegative, symmetrical synovitis with pitting oedema (RS3PE) is an uncommon, late-onset, rheumatic syndrome [1] featuring acute onset of polyarthritis with pitting oedema, negative rheumatoid factor (RF), absence of joint erosions on radiographs, synovitis evidenced by imaging and a remarkable response to low-dose steroids, with a sustained response [2]. Pitting oedema is prominent in the dorsum of the hand and foot. Aetiology of RS3PE syndrome is still unknown. Possible associations with human leukocyte antigens (HLA), malignancy, and parvovirus B19 infection have been proposed and cases accompanied by other rheumatoid and autoimmune disorders have been reported raising suspicion of underlying autoimmunity in the pathogenesis of RS3PE syndrome [3]. It is believed to be a paraneoplastic rheumatic disease as it is noted to be associated with a variety of malignancies as well. Vascular endothelial growth factor (VEGF) appears to have a role in the pathogenesis of this disease. Patients with RS3PE, without underlying malignancy, respond well to steroids and carry a good prognosis [1].

Idiopathic, remitting, seronegative, symmetrical synovitis with pitting oedema (RS3PE) – an overlooked clinical entity?