181 - A Complex Pain Presentation

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

TM

Tegan M. Morcott, BA

Medical Student
Chicago Medical School at Rosalind Franklin
Lake Forest, Illinois, United States

Co-Author(s)

BS

Brian Singer, MD

MD
Burke Rehabilitation Hospital
White Plains, New York, United States
Raul E. Rodriguez-Ramos, MD

MD
Burke Rehabilitation Hospital
White Plains, New York, United States
SB

Sharon Bushi, MD

MD
Burke Rehabilitation Hospital
White Plains, New York, United States

Case Diagnosis: Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE)

Case Description:   56-year-old male with a past medical history of chronic pain secondary to Complex Regional Pain Syndrome and diabetes mellitus type 2 with diabetic neuropathy, presented with acute worsening of pain and decreased functional status. He presented to ED unresponsive after an episode of severe pain with generalized weakness and gait instability.  EEG was negative for seizure, CT was negative for acute process, laboratory markers were within normal limits including negative RF and ANA. Patient reported his CRPS began following an accident at work years prior injuring the right hand that spread to the left hand, chest, and abdomen. He arrived at our rehabilitation hospital with limited range of motion and required assistance for ADLs. Following treatment, patients functionality and ambulation ability improved.

Discussions: Previous treatment for complex regional pain syndrome did not improve his pain or functional ability. Thorough history revealed severe bilateral hand pitting edema at the onset of his acute polyarthritis concerning for seronegative symmetrical synovitis with pitting edema which was supported with absence of RF factor, negative ANA and his age greater than 50 (1,2,3).  After treatment with 10mg daily prednisone for 1 week, the patient showed significant reduction in pain, stopped opioid medications and had a drastic improvement in function, supporting a diagnosis of remitting seronegative symmetrical synovitis with pitting edema (1). 

Conclusions: Patients with seronegative symmetrical synovitis typically present with pitting edema and demonstrate exquisite response to low dose steroids. When the patient was trialed on 10mg of prednisone for 7 days (adjusted from a dose of 15mg due to history of diabetes) he showed drastic improvement in level of pain and functionality. A proper diagnosis of seronegative symmetrical synovitis with pitting edema is essential in providing pain relief and avoiding improper treatment (1). 