Remitting seronegative symmetrical synovitis with pitting edema(RS3PE),the inflammatory arthritis attacking mainly elderly males,is characterized by symmetrical synovitis with pitting edema of the dorsum of hands and feet and the absence of rheumatoid factor.RS3PE commonly accompanies malignant tumor,infections and other diseases.Here we report a case of RS3PE associated with lung malignancy and review other six cases to summarize the clinical features,treatment and prognosis.
Aged ; Edema/etiology* ; Humans ; Lung Neoplasms/complications* ; Male ; Syndrome ; Synovitis/drug therapy*

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovitis and damage of bone and cartilage. The major goals of therapy in RA are to relieve pain, swelling of joints; improve joint function; stop joint damage, and prevent disability and disease-related morbidity. The past decade has seen a major transformation in the treatment of RA in terms of approach and choice of drugs. The previous therapeutic approach, termed the therapeutic pyramid, penerally involved initial conservative management with non-steroidal anti-inflammatory drugs (NSAIDs) for several years; disease-modifying antirheumatic drugs (DMARDs) were withheld until clear evidence of erosions was seen. DMARDs were then added individually in slow succession as the disease progressed. This form of treatment has been supplanted by early initiation of DMARDs and combination DMARD therapy in patients with the potential for progressive disease. The idea of early intervention with DMARDs has been validated in several randomised trials. This paradigm shift partly resulted from unsatisfactory outcomes with the pyramid approach, and an increased awareness of the cost, lost productivity, morbidity, and decreased life expectancy associated with RA. These findings are the consequences of progressive disease, and have provided the impetus for development of more effective therapies to prevent joint destruction and maintain functional status. The continuing elucidation of pathophysiological pathways relevant in RA, coupled with advanced in biotechnology, offer substantial hopes for the development of potent and specific pharmacotherapy for RA.
Antirheumatic Agents ; Arthritis, Rheumatoid* ; Biotechnology ; Cartilage ; Drug Therapy ; Early Intervention (Education) ; Efficiency ; Hope ; Humans ; Joints ; Life Expectancy ; Synovitis

OBJECTIVE: To investigate the anti-arthritic effect of bee venom in adjuvant induced arthritis (AIA) in rats. METHODS: Thirty-two male SD rats were enrolled in the experiment. Six were treated as negative controls and 20 AIA models were randomly divided into 3 groups: model controls (n=6), sodium chloride treatment group (n=6), and bee venom treatment group (n=8). The rats in the model control were killed before the treatment and the peripheral blood and synovium samples were collected for pre-treatment controls. The rats in the bee venom treatment group were injected hypodermically with bee venom for 14 days, while those in the sodium chloride treatment group were treated with the same volume of sodium chloride. During this period, the circumference of the affected joints and the total scores of the joints in all groups were measured every 2 days and X ray examinations were performed before and after the treatment. At the end of the treatment, all the rats were killed and their peripheral blood and synovium samples were collected for measurements of tumor necrosis factor TNF-alpha and interleukin IL-1 beta and histological studies, respectively. RESULTS: Compared with the sodium chloride group, the rats in the bee venom treatment group were less swollen in joints and circumference of joints and lower joint scores decreased (P<0.05). At the same time, the bone erosion and the infiltration of inflammatory cells in the synovium were also significantly reduced in the bee venom treatment group. In addition, the serum concentrations of TNF-alpha and IL-1 beta were significantly lower in rats of the bee venom treatment group than those of the sodium chloride group (P<0.05 and P<0.01, respectively). CONCLUSION Bee venom is effective in treating AIA by reducing synovitis, downregulating the serum concentrations of cytokine TNF-alpha and IL-1 beta and alleviating the bone erosion.
Animals ; Arthritis, Experimental ; drug therapy ; Bee Venoms ; therapeutic use ; Interleukin-1beta ; blood ; Male ; Rats ; Rats, Sprague-Dawley ; Synovial Membrane ; pathology ; Synovitis ; drug therapy ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo prove the therapeutic effects of Sihuang powder (composed by four traditional Chinese herbs: root of baikal skullcap, bark of amur corktree, root of sorrel rhubarb, fruit of cape jasmine, which were mixed with wild Chrysanthemum flower solution)in treating acute synovitis in experimental rabbit knee osteoarthritic models induced by papain injection and to explore its mechanism.

METHODSThirty-two New-Zealand white rabbits were divided into 6 groups: blank group, model group, Sihuang powder with high dosage group (2 g/kg), Sihuang powder with low dosage group (1 g/kg), Yingtaiqing group and wild Chrysanthemum flower group. The latter four groups were treated respectively with low and high dose Sihuang powder synovium and cartilage were tested concentrations of nitrogen monoxide (NO) and IL-1 level and then were prepared for pathologic and histologic observation 10 days later. Cartilage pathologic changes were record and synovium pathologic changes were valued by means of Mankin's value system.

RESULTSThe NO concentration of synovium in Sihuang powder with high dosage group was lower than that of model group, and there was significantly differences between the two groups (P < 0.01). The IL-1 level of synovium was failed after treated with Sihuang powder with high dosage (P < 0.05). Sihuang powder with low dosage and Yingtaiqing also could restrain IL-1's release (P < 0.05). In Mankin's value system, Sihuang powder with high dosage almost eliminated inflammatory cells infiltrating in synovium, which was seldom found in other groups. The value of Sihuang powder with high dosage group was the lowest in treatment groups (P < 0.005). Sihuang powder with low dosage group and wild Chrysanthemum flower group also decreased the degree of inflammatory in synovium (P < 0.05).

CONCLUSIONSihuang powder can reduce the concentration of NO and IL-1 and improve inflammatory cell infiltrate in lining cells of synovium. Moreover, it can alleviate swelling and pain of joint, improve joint movement and postpone degeneration of the cartilage.

Acute Disease ; Animals ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Interleukin-1 ; analysis ; Nitric Oxide ; analysis ; Osteoarthritis ; drug therapy ; pathology ; Papain ; toxicity ; Powders ; Rabbits ; Synovitis ; chemically induced ; drug therapy ; pathology