RS3PE Syndrome with Subsequent PMR Caused by Long-Term DPP-4 Inhibitor Use

Area of Science:

• Rheumatology
• Endocrinology
• Pharmacology

Background:

• Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome is a rare condition.
• Dipeptidyl peptidase-4 inhibitors (DPP-4i) are commonly used for type 2 diabetes management.
• Previous reports suggest a link between DPP-4i and RS3PE syndrome.

Purpose of the Study:

• To report a case of RS3PE syndrome and polymyalgia rheumatica (PMR) in a patient using vildagliptin, a DPP-4i.
• To highlight the potential for DPP-4i to cause these rare rheumatological conditions.
• To emphasize the importance of considering drug side effects in the differential diagnosis.

Main Methods:

• Case report of a 73-year-old male with type 2 diabetes.
• Observation of RS3PE syndrome and PMR development during vildagliptin treatment.
• Review of literature on DPP-4i associated rheumatological adverse events.

Main Results:

• The patient developed RS3PE syndrome as a side effect of vildagliptin.
• The patient subsequently developed polymyalgia rheumatica (PMR), a novel association with long-term DPP-4i use.
• This case expands the known spectrum of DPP-4i-induced rheumatological complications.

Conclusions:

• RS3PE syndrome and PMR are rare causes of painful extremities.
• The potential association between DPP-4i and these conditions requires further investigation.
• Drug-induced side effects should be considered in the differential diagnosis of RS3PE syndrome and PMR, alongside malignancy and giant cell arteritis.