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• W2507746209 abstract "To the Editor: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) can be related to neoplasia, but the association between each of these syndromes and myeloma is rare, particularly in elderly adults.1, 2 A case of RS3PE associated with myeloma and SIADH is reported herein. An 83-year-old man was hospitalized for progressive general weakness with weight loss of 10 kg in 2 months. Clinical examination revealed inflammatory metacarpophalangeal arthralgia, a winding defect of the fingers, puffy hands with soft pitting edema, synovitis of the wrists, and left gonarthritis. The biological tests showed aregenerative microcytic anemia (hemoglobin 9.1 g/dL; normal 13–18 g/dL), thrombocytosis (platelets 657,000 cells/μL; normal 150,000–450,000 cells/μL), an inflammatory syndrome (high C-reactive protein (113 mg/L), erythrocyte sedimentation rate 50 mm/h), and hyponatremia (serum sodium 124 mmol/L, normal 135–145 mmol/L). Autoimmune testing, including rheumatoid factor, antinuclear antibodies, anticitrullinated peptide antibodies, and soluble antinuclear antigen antibodies, showed no anomalies. Because of the hyponatremia, other biological tests were performed. Natriuresis was 61 mmol of sodium/L (normal 50–300 mmol/L), plasma osmolality was 267 mOsm/kg (normal 290 ± 5 mOsm/kg), and urinary osmolality was 370 mOsm/kg (normal 600–800 mOsm/kg). The X-ray showed no erosions but bilateral defects at the ischiopubic rami and a fourth lumbar one-eye vertebra. The clinical and biological features led to a diagnosis of RS3PE, and other associated biological disorders led to the diagnosis of SIADH. Serum protein electrophoresis with immunofixation revealed an immunoglobulin G kappa, and myelogram showed plasmacytosis at 18%. Thus, myeloma was diagnosed. Treatment consisted of corticoid therapy at 20 mg/d with fluid restriction. Chemotherapy was not indicated because of the low myeloma activity. After 3 months of treatment, the general weakness, arthralgia, and inflammatory syndrome vanished, with no increase in monoclonal immunoglobulin level. This is the first reported case of an association between RS3PE, myeloma, and SIADH. Few cases of associations between RS3PE and myeloma1 and between SIADH and myeloma2 have been reported, and to the knowledge of the authors, there have been no reports associating the three diagnoses. RS3PE is a seronegative edematous acute polyarthritis.3 Diagnosis is based on bilateral pitting edema of hands, acute polyarthritis, older age, and absence of rheumatoid factor. RS3PE is rare but underdiagnosed. Its clinical presentation can mimic seronegative rheumatoid polyarthritis and it can be associated with inflammatory rheumatic diseases or connective tissue disease but also be paraneoplastic. Several cases of RS3PE associated with cancers, mainly solid cancers, including prostatic, gastric, and colonic adenocarcinomas, have been described.4 Some cases of RS3PE associated with hemopathy, particularly non-Hodgkin's lymphoma,5 myelodysplasia,6 and chronic lymphocytic leukemia,7 have also been reported, but only two cases of RS3PE associated with myeloma had been reported in elderly adults.1, 8 In individuals with paraneoplastic RS3PE, general signs such as general weakness or febricula are frequent, which is not the case in nonparaneoplastic RS3PE. In addition, corticoid therapy is less effective in paraneoplastic RS3PE than in nonparaneoplastic RS3PE. The dose of corticoid therapy necessary to control the disease in the man describe herein, 10 mg/d, was higher than usual. RS3PE can reveal cancer and can change in parallel with the cancer, disappearing during remissions and reappearing during recurrences.4 This man also had SIADH, which can be paraneoplastic; SIADH is found in 1% to 2% of individuals with cancer.9 This association is even greater with small cell lung cancer (10–45%).9 Esophageal carcinoma; ear, nose, and throat cancer; and myeloma are other cancers in which SIADH has been reported.2, 10 RS3PE is a real paraneoplastic syndrome. The presence of atypical elements, including general weakness and febricula, requires corticoid therapy greater than 10 mg/d. In addition, the presence of another paraneoplastic syndrome (e.g., SIADH) must lead the physician to search for neoplasia. The authors are grateful to Mr. Philip Bastable. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Mahmoudi: study concept, acquisition of subject and data, analysis and interpretation of data, preparation of manuscript. Lebrun: acquisition of subject and data. Novella: preparation of manuscript. Manckoundia: interpretation of data, preparation of manuscript. Sponsor's Role: No sponsor." @default.
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• W2507746209 date "2016-08-22" @default.
• W2507746209 modified "2023-09-23" @default.
• W2507746209 title "Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome Associated with Myeloma and Syndrome of Inappropriate Antidiuretic Hormone Secretion in an Elderly Man" @default.
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• W2507746209 doi "https://doi.org/10.1111/jgs.14360" @default.
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