Remitting Seronegative Symmetrical Synovitis and Pitting Edema Syndrome After Administration of a Dipeptidyl Peptidase-4 Inhibitor, Alogliptin, in a Patient With Type 2 Diabetes

Abstract

A 57-year-old Japanese man with type 2 diabetes presented with bilateral pitting edema and pain of the hands and feet two months after being initiated on a dipeptidyl peptidase-4 (DPP-4) inhibitor, alogliptin. Laboratory tests showed elevated levels of C-reactive protein, matrix metalloproteinase-3 and vascular endothelial growth factor, and a negative rheumatoid factor. The computed tomography scan showed swelling in the dominant right wrist joint, and joint ultrasonography showed synovial swelling. He was diagnosed with remitting seronegative symmetrical synovitis and pitting edema (RS3PE) syndrome. Alogliptin was discontinued and prednisolone was initiated, thereafter, his symptoms quickly improved. As for his glycemic control, his hemoglobin A1c (HbA1c) went from an initial 9.1% to 8.3% once alogliptin was initiated. However, after being diagnosed with RS3PE syndrome, his treatment was changed from alogliptin to metformin, and his HbA1c remained between 6% and 7%. The diagnosis of RS3PE syndrome should be considered if pitting edema and arthralgia in the extremities are observed after initiating patients with type 2 diabetes on DPP-4 inhibitors.