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:
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.
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
Case characteristics

A 71-year-old woman was referred to our hospital with finger stiffness; edema of both hands and feet; and bilateral pain in the shoulder, wrist, metacarpophalangeal, proximal interphalangeal, and ankle joints.

Clinical diagnosis

Physical examination showed remarkable pitting edema in the dorsum of the hands and feet, as well as bilateral tenderness and swelling in the shoulder, wrist, finger, and ankle joints.

Differential diagnosis

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome and rheumatoid arthritis were considered.

Laboratory diagnosis

Blood test results were as follows: WBC, 5100/μL (neutrophils, 75%); CRP, 20.8 mg/dL; erythrocyte sedimentation rate, 99 mm/h; RF, negative; matrix metalloproteinase 3 (MMP-3) 488 ng/mL; VEGF, 135 pg/mL; HLA-B 7, (+).


Treatment with prednisolone (15 mg/d) was started.

Experiences and lessons

We report a patient with RS3PE syndrome and elevation of MMP-3. MMP-3 was more indicative of RS3PE syndrome symptoms than was CRP.