Rheumatoid arthritis is a heterogenous disease presenting with different clinical pictures and different onset in young and elderly people. In this case report an elderly RS3PE Syndrome patient with pitting edema over the hands and feet with acute inflamma-tory findings was reviewed. Generalized edema on hands, wrists and feet were observable and had developed in a quite short time period. On examination we found joint pain, increase in skin tem-perature and limitation of motions of the joints in addition to edema. These disturbing findings caused a restriction of daily living activities besides occupational activities. Laboratory analysis re-vealed erythrocyte sedimentation rate to be 43 mm/h, rheumatoid factor was negative while CRP was found to be 22.6 ngr/l (normal limits were between 0 and 6 ngr/l. The patient was 58 years old, male and teacher. Follow-up examinations were performed for 5 years and except mild, infrequent periods of flare-ups from time to time the patient has no functional losses and is continuing his professional activities. Together with the rise of old population there is an increase in old RA patients. These patients show different diagnostic and therapeutic characteristics. The differential diagnosis of inflammatory conditions in elderly patients presenting with symmetrical edema on hands and feet should include RA of elderly people as well as RS3PE. Sudden onset, great sensitivity of inflammation to glucocorticoid therapy and absence of joint erosion were observed in this patient. RS3PE Syndrome should be considered in elderly patients in differential diagnosis. Appreciating the differences between young and elderly onset RA should also advance the choice of treatment.