Chronic Hand Edema in Rheumatoid Arthritis: A Rare Extra-Articular Manifestation

Patients with rheumatoid arthritis (RA) usually present with swelling of hands and feet due to synovitis of the small joints. Chronic edema limited to the extremities is rarely reported in the literature. We report the case of a 55- year-old-patient, with 37 years of seropositive and deforming RA associated with Sjogren’s syndrome, initially treated with corticosteroids for 17 years, currently on Leflunomide for 20 years. Her disease has been in remission for 3 years. The course was marked by the gradual onset of bilateral, symmetrical, persistent and diffuse edema in both hands for the past 20 years. It was a significant, painless and elastic infiltration of the dorsum of the hands and the fingers. The skin was tight but normal, with a positive Stemmer’s sign, which suggested the lymphatic origin of the oedema. The patient flexed her fingers with difficulty. There was no infiltration of the rest of the upper nor the lower limbs. Among the extra articular signs of RA, chronic edema of the limbs remains unusual and often unrecognized. The pathophysiological mechanism is not well understood. Treatment is poorly codified. The prognosis is primarily functional.