Remitting distal lower extremity swelling with pitting oedema in acute sarcoidosis.

Remitting distal extremity swelling with pitting oedema is a clinical manifestation that may be observed in diVerent rheumatic conditions such as RS3PE syndrome, 1 polymyalgia rheumatica, late onset undiVerentiated spondyloarthropathy, ankylosing spondylitis, psoriatic arthritis, and more rarely in other rheumatic disease. In RS3PE the swelling with pitting oedema predominantly involves the upper extremities symmetrically. This clinical finding may occur unilaterally in polymyalgia rheumatica and upper and lower limbs may be equally aVected, whereas in seronegative spondyloarthropathies it has been described more frequently in lower extremities with asymmetric involvement. 4 The oedema is characterised by a rapid response to small doses of corticosteroids. The pathogenesis of swelling with pitting oedema has not been completely defined, but the distribution along the tenosynovial membranes suggests that it probably results from tenosynovitis. Sarcoidosis is a systemic granulomatous disease that is associated with rheumatic manifestations in 6% to 39% of patients. The most common form of arthritis occurs acutely, involves preferentially the ankles, and