Remitting Seronegative Symmetrical Synovitis with Pitting Edema in a Patient with Diabetes Mellitus Receiving Saxagliptin

Abstract

We described a rare case of RS3PE associated with DPP-4 inhibitor (saxagliptin) therapy in a diabetic patient with no evidence of another underlying pathology. To the best of our knowledge, this is the first case report of RS3PE associated with saxagliptin. The patient presented with acute onset of swelling and pain in multiple peripheral joints, swelling of the dorsum of the hands and feet occurred a month after the initiation of saxagliptin. Laboratory results were remarkable for elevated acute phase reactants. The diagnosis of RS3PE was made through exclusion and was based on acute onset of pitting edema, synovitis shown by ultrasound and magnetic resonance investigation, absence of joint erosions and negative rheumatoid factor. Patient showed a good response to low dose of steroids with a complete and sustained remission. The development of RS3PE following introduction of drug should suggest this drug as a possible trigger for the development of RS3PE.