Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2018; 6(5): 84-87
Published online May 16, 2018. doi: 10.12998/wjcc.v6.i5.84
Serum matrix metalloproteinase 3 in detecting remitting seronegative symmetrical synovitis with pitting edema syndrome: A case report
Tsuneaki Kenzaka, Ken Goda
Tsuneaki Kenzaka, Ken Goda, Department of Internal Medicine, Hyogo Prefectural Kaibara Hospital, Hyogo 669-3395, Japan
Tsuneaki Kenzaka, Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Hyogo 652-0032, Japan
Author contributions: Kenzaka T assisted with redaction, correction, and reconstruction of the manuscript; Goda K managed the case and redaction and correction of the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tsuneaki Kenzaka, MD, PhD, Professor, Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Hyogo 652-0032, Japan. smile.kenzaka@jichi.ac.jp
Telephone: +81-78-3826732 Fax: +81-78-3826283
Received: December 22, 2017
Peer-review started: December 22, 2017
First decision: February 9, 2018
Revised: February 15, 2018
Accepted: March 7, 2018
Article in press: March 7, 2018
Published online: May 16, 2018
Abstract

We report a case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in a 71-year-old woman. She referred to our hospital with finger stiffness, edema of both hands and feet, pain of bilateral shoulder, wrist, metacarpophalangeal, proximal interphalangeal, and ankle joints. Rheumatoid factor was negative, human leukocyte antigen -B7 antigen was positive. Moreover, matrix metalloproteinase 3 (MMP-3) was high. She was diagnosed with RS3PE syndrome, and treatment with prednisolone (15 mg/d) was started. One week after prednisolone treatment initiation, CRP decreased to negative, and joint pain was almost completely resolved. However, hand stiffness persisted, and MMP-3 level was still high. Thus, prednisolone dose was increased to 20 mg/d, and the stiffness resolved. Twenty days after treatment initiation, MMP-3 was normalized. MMP-3 was more indicative of RS3PE syndrome symptoms than CRP. Thus, MMP-3 seems to be more sensitive to RS3PE syndrome symptoms.

Keywords: Serum matrix metalloproteinase 3, Remitting seronegative symmetrical synovitis with pitting edema syndrome

Core tip: We report a patient with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome and elevation of matrix metalloproteinase 3 (MMP-3). MMP-3 was more indicative of RS3PE syndrome symptoms than CRP. Although the study of additional cases is necessary, MMP-3 seems to be more sensitive to RS3PE syndrome symptoms.