The case histories of 13 elderly patients (8 men/5 women) with a relatively acute onset of a severe symmetrical synovitis affecting the flexor digitorum tendon sheaths and wrist joints with pitting edema of the dorsum of both hands are described. All were persistently seronegative for IgM rheumatoid factors and all went into complete remission without relapse. Asymptomatic residual flexion contractures of the fingers and wrists were a constant feature during remission. HLA-B7 was present in 15 of a total 23 reported cases (relative risk = 4.4). This condition, with its excellent prognosis, is differentiated from rheumatoid arthritis and polymyalgia rheumatica.