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Cases of remitting seronegative symmetrical synovitis with pitting edema syndrome, presenting as symmetrical synovitis with dorsal hand and foot edema, have also been reported in individuals receiving DPP-4 inhibitors [13, 34]

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During discontinuation and washout, a structured plan to minimize weight regain and glycaemic deterioration is advisablefor example, reinforcing dietary/physical-activity targets and, where clinically indicated, using metformin as a maintenance optionso that metabolic stability is preserved before ART initiation