BACKGROUNDRemitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare inflammatory disease of unknown etiology, characterized by edema of the extremities and arthritis, which mainly affects patients over 50 years of age.Rheumatoid factor and anti-CCP are usually negative. The syndrome can be isolated or related with other diseases. There are reports of paraneoplastic association with prostate, lung, lymphoproliferative and gastrointestinal tumors. This patient was diagnosed with gastrointestinal stromal tumor (GIST), for which there are no publications with a direct relation with RS3PE. Patients diagnosed with RS3PE usually present good response to corticosteroids, as was the case of our patient. CASE REPORTA 63-year-old man, previously hypertensive and heavy drinker was admitted for severe COVID-19 infection, needing intubation and hemodialysis. During hospitalization, he developed knee monoarthritis, and an arthrocentesis revealed cloudy synovial fluid, 7,429 leukocytes/µL, with negative gram stain and culture. He was treated as possible septic arthritis due to prolonged hospitalization, multiple infections and use of broad-spectrum antibiotic therapy, with improvement After medical discharge, the patient developed symmetrical polyarthritis of the hands, feet, ankles and knees, prolonged morning stiffness, pitting edema of hands and feet. An extensive investigation was carried out in the outpatient clinic and reactive arthritis, gout, and rheumatoid arthritis were excluded. Investigation of possible associated neoplasia was initiated, due to persistent iron deficiency anemia, weight loss, and melena. Diagnosis of GIST was made by computed tomography of the abdomen and upper digestive endoscopy, and it was surgically resected. The patient was treated with prednisone 10 mg/day and showed improvement in the joint condition.

objeCtives: Chronic migraine (CM) is a disabling disorder that significantly reduces quality of life. Guidelines recommend preventive medications as the standard of care for patients with frequent migraine. Real-world analyses have shown that adherence and persistence to oral migraine preventive medications (OMPMs) is poor. However, previous research has focused on specific individual OMPM. Few studies to date have explored adherence and persistence to any OMPM. This research aims to assess OMPM persistence and adherence among newly diagnosed CM patients. Methods: A retrospective analysis of medical and pharmacy claims from the Scott and White Health Plan. First documentation of CM diagnosis from December 2011 to December 2013 was defined as the index date. Patients were required to be ≥ 18 years of age, and have continuous enrollment 6 months preindex and 12 months post-index. The proportion of days covered (PDC) was calculated for all patients with at least 2 fills for any of the 25 included OMPMs. PDC was assessed from the first OMPM fill date to the end of the follow-up period (12 months post index diagnosis). A PDC cutoff ≥ 0.8 was used to classify adherence. Non-persistence was defined as an OMPM supply gap > 45 days. Results: Of the 283 eligible CM patients enrolled into the study, 221 (78.1%) patients had at least 1 OMPM fill and were included in the persistence analysis, and 203 (71.7%) patients had at least 2 OMPM fills and were included in the adherence analysis. The mean [standard deviation] PDC was 0.76 [0.25]. Using a PDC cutoff of ≥ 0.8, 117 (57.6%) CM patients were adherent to any OMPM. Forty-six (20.8%) CM patients did not persist with any OMPM. The mean time to treatment discontinuation was 89.4 days [68.2 days]. ConClusions: This real-world study demonstrated low adherence and persistence to any OMPM among CM patients.