FDG-PET/CT Findings in a Patient with Polymyalgia Rheumatica and Accompanying Remitting Seronegative Symmetrical Synovitis with Pitting Edema


1 Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark

2 University of Southern Denmark, Odense, Denmark

3 Department of NuclearMedicine, Odense University Hospital, Odense, Denmark


Abstract Background: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare, but well-defined syndrome com- prising polyarthritis with symmetrical synovitis of the small joints in hands and feet accompanied by marked pitting edema. It is often considered a paraneoplastic syndrome, but here we report a case with F-18-fluorodeoxyglucose positron emission tomog- raphy/computed tomography (FDG-PET/CT) findings of polymyalgia rheumatica (PMR) in a patient with RS3PE and suspected of paraneoplastic syndrome. Objectives: To briefly report the potential of FDG-PET/CT in rheumatic settings. Methods: An 83-year-oldmalewith a history of prostate adenocarcinoma simultaneouslywith RS3PE presentedwith pain and stiff- ness of the shoulder and hip girdles to the department of rheumatology. He was anemic and had hypersedimentation of 106. He also complained of sore and swollen hands compatiblewith RS3PE. The patient had a previous course of RS3PE, presented as a para- neoplastic syndrome, togetherwith his prostate cancer one year earlier,which resolvedwhen the prostatic cancerwas in remission. FDG-PET/CT was performed due to suspicion of repeat paraneoplastic syndrome. Results: FDG-PET/CT findings showed no evidence of malignant disease. Therewas diffusely increased FDG in soft tissue around the shoulders and hips and FDG-positive axillary lymph nodes consistent with PMR. Conclusions: RS3PE and PMRmay belong to the same clinical entity. FDG-PET/CT has a potential role in themanagement of PMR as well as other rheumatic diseases.


  1. 1.McCarty DJ, O’Duffy JD, Pearson L, Hunter JB. Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome. JAMA. 1985;254(19):2763–7. [PubMed: 4057484].

    1. Olivieri I, Salvarani C, Cantini F. RS3PE syndrome: an overview. Clin Exp Rheumatol. 2000;18(4 Suppl 20):S53–5. [PubMed: 10948764].
    2. Perandones CE, Colmegna I, Arana RM. Parvovirus B19: another agent associated with remitting seronegative symmetrical synovitis with pitting edema. J Rheumatol. 2005;32(2):389–90. [PubMed: 15693107].
    3. Manger B, Schett G. Paraneoplastic syndromes in rheumatology. Nat Rev Rheumatol. 2014;10(11):662–70. doi: 10.1038/nrrheum.2014.138. [PubMed: 25136782].
    4. Emamifar A, Gildberg-Mortensen R, Andreas Just S, Lomborg N, Asmussen Andreasen R, Jensen Hansen IM. Level of Adherence to Prophylactic Osteoporosis Medication amongst Patients with Polymyalgia Rheumatica and Giant Cell Arteritis: A Cross-Sectional Study. Int J Rheumatol. 2015;2015:783709. doi: 10.1155/2015/783709. [PubMed: 26491449].
    5. Salvarani C, Cantini F, Olivieri I. Distal musculoskeletal manifestations in polymyalgia rheumatica. Clin Exp Rheumatol. 2000;18(4 Suppl 20):S51–2. [PubMed: 10948763].
    6. Hess S, Blomberg BA, Zhu HJ, Hoilund-Carlsen PF, Alavi A. The pivotal role of FDG-PET/CT in modern medicine. Acad Radiol. 2014;21(2):232– 49. doi: 10.1016/j.acra.2013.11.002. [PubMed: 24439337].
    7. Kristensen SB, Hess S, Petersen H, Hoilund-Carlsen PF. Clinical value of FDG-PET/CT in suspected paraneoplastic syndromes: a retrospective analysis of 137 patients. Eur J Nucl Med Mol Imaging. 2015;42(13):2056– 63. doi: 10.1007/s00259-015-3126-2. [PubMed: 26194717].
    8. Hess S, Hansson SH, Pedersen KT, Basu S, Hoilund-Carlsen PF. FDG-PET/CT in Infectious and Inflammatory Diseases. PET Clin. 2014;9(4):497–519. doi: 10.1016/j.cpet.2014.07.002. [PubMed: 26050949] vi-vii.
    9. Bjorn Kristensen S, Hess S. FDG-PET/CT in rheumatoid arthritis: A review. Curr Mol Imaging. 2015;3(3):206–10. doi: 10.2174/2211555204666150619154910.
    10. Nanni CFS. PET-CT: Rare findings and diseases berlin-heidelberg. Springer; 2012. pp. 93–5.
    11. Emamifar A, Hess S, Gildberg-Mortensen R, Jensen Hansen IM. Association of Remitting Seronegative Symmetrical Synovitis with Pitting Edema, Polymyalgia Rheumatica, and Adenocarcinoma of the Prostate. Am J Case Rep. 2016;17:60–4. [PubMed: 26839040].