A 82-year-old Asian male was admitted to the Department of General Internal Medicine with 2-month history of symmetrical swelling in both hands. The swelling was localized to the dorsum of hands and did not extend to the face and lower extremities. He had no dyspnea on exertion and orthopnea. He had good appetite, and there was no significant history of weight loss. He denied any history of jaundice in the past. Despite treatment with loop diuretics furosemide 40 mg daily, his condition did not respond to the medication and his quality of life deteriorated. Therefore, he visited our hospital and requested an alternative treatment. On physical examination, his vitals were stable with blood pressure of 147/85 mmHg and heart rate of 98 beats per minute. He had swelling restricted to the dorsum of both hands with pitting edema. Examination of the joints showed tenderness suggestive of synovitis with restricted movements in bilateral proximal interphalangeal joint. Other clinical examinations including cardiovascular, respiratory, abdominal, and neurological examinations were unremarkable. Laboratory findings revealed hyperglycemia, elevated erythrocyte sedimentation rate (ESR) of 118 mm/hour, and elevated C-reactive protein (CRP) of 6.58 mg/dL, and slight anemia with hemoglobin of 12.1 g/dL. Plain radiographs of both hands showed soft tissue swelling with neither narrowing of the joint spaces nor bone erosion. At this point, the diagnosis of bilateral RS3PE was made. Treatment with prednisolone 15 mg daily was instituted. At follow-up after hospitalization, dramatic improvement of all his symptoms was noted. The swelling on the dorsum of his hands had drastically resolved. At 1 week follow-up after hospitalization, ESR and CRP had returned to normal. He was discharged on hospital day 12 and continues to be followed up on an outpatient basis. He remained symptom free at 2-week review on prednisolone 15 mg daily, which was then reduced to 10 mg daily. Thereafter, the prednisolone dose was reduced by 1 mg every 4 weeks, and he has progressed without any flare-up of inflammation.