diff --git a/src/server/index.ts b/src/server/index.ts
index a22c592..0e6f2c9 100644
--- a/src/server/index.ts
+++ b/src/server/index.ts
@@ -7,6 +7,7 @@ import { totalRoutes } from "./routes/totals.ts";
 import { imageRoutes } from "./routes/images.ts";
 import { settingsRoutes } from "./routes/settings.ts";
 import { threadRoutes } from "./routes/threads.ts";
+import { setupRoutes } from "./routes/setups.ts";
 
 // Seed default data on startup
 seedDefaults();
@@ -25,6 +26,7 @@ app.route("/api/totals", totalRoutes);
 app.route("/api/images", imageRoutes);
 app.route("/api/settings", settingsRoutes);
 app.route("/api/threads", threadRoutes);
+app.route("/api/setups", setupRoutes);
 
 // Serve uploaded images
 app.use("/uploads/*", serveStatic({ root: "./" }));
diff --git a/src/server/routes/setups.ts b/src/server/routes/setups.ts
new file mode 100644
index 0000000..c553754
--- /dev/null
+++ b/src/server/routes/setups.ts
@@ -0,0 +1,84 @@
+import { Hono } from "hono";
+import { zValidator } from "@hono/zod-validator";
+import {
+  createSetupSchema,
+  updateSetupSchema,
+  syncSetupItemsSchema,
+} from "../../shared/schemas.ts";
+import {
+  getAllSetups,
+  getSetupWithItems,
+  createSetup,
+  updateSetup,
+  deleteSetup,
+  syncSetupItems,
+  removeSetupItem,
+} from "../services/setup.service.ts";
+
+type Env = { Variables: { db?: any } };
+
+const app = new Hono<Env>();
+
+// Setup CRUD
+
+app.get("/", (c) => {
+  const db = c.get("db");
+  const setups = getAllSetups(db);
+  return c.json(setups);
+});
+
+app.post("/", zValidator("json", createSetupSchema), (c) => {
+  const db = c.get("db");
+  const data = c.req.valid("json");
+  const setup = createSetup(db, data);
+  return c.json(setup, 201);
+});
+
+app.get("/:id", (c) => {
+  const db = c.get("db");
+  const id = Number(c.req.param("id"));
+  const setup = getSetupWithItems(db, id);
+  if (!setup) return c.json({ error: "Setup not found" }, 404);
+  return c.json(setup);
+});
+
+app.put("/:id", zValidator("json", updateSetupSchema), (c) => {
+  const db = c.get("db");
+  const id = Number(c.req.param("id"));
+  const data = c.req.valid("json");
+  const setup = updateSetup(db, id, data);
+  if (!setup) return c.json({ error: "Setup not found" }, 404);
+  return c.json(setup);
+});
+
+app.delete("/:id", (c) => {
+  const db = c.get("db");
+  const id = Number(c.req.param("id"));
+  const deleted = deleteSetup(db, id);
+  if (!deleted) return c.json({ error: "Setup not found" }, 404);
+  return c.json({ success: true });
+});
+
+// Setup Items
+
+app.put("/:id/items", zValidator("json", syncSetupItemsSchema), (c) => {
+  const db = c.get("db");
+  const id = Number(c.req.param("id"));
+  const { itemIds } = c.req.valid("json");
+
+  const setup = getSetupWithItems(db, id);
+  if (!setup) return c.json({ error: "Setup not found" }, 404);
+
+  syncSetupItems(db, id, itemIds);
+  return c.json({ success: true });
+});
+
+app.delete("/:id/items/:itemId", (c) => {
+  const db = c.get("db");
+  const setupId = Number(c.req.param("id"));
+  const itemId = Number(c.req.param("itemId"));
+  removeSetupItem(db, setupId, itemId);
+  return c.json({ success: true });
+});
+
+export { app as setupRoutes };
diff --git a/src/server/services/setup.service.ts b/src/server/services/setup.service.ts
new file mode 100644
index 0000000..f19bdb5
--- /dev/null
+++ b/src/server/services/setup.service.ts
@@ -0,0 +1,111 @@
+import { eq, sql } from "drizzle-orm";
+import { setups, setupItems, items, categories } from "../../db/schema.ts";
+import { db as prodDb } from "../../db/index.ts";
+import type { CreateSetup, UpdateSetup } from "../../shared/types.ts";
+
+type Db = typeof prodDb;
+
+export function createSetup(db: Db = prodDb, data: CreateSetup) {
+  return db
+    .insert(setups)
+    .values({ name: data.name })
+    .returning()
+    .get();
+}
+
+export function getAllSetups(db: Db = prodDb) {
+  return db
+    .select({
+      id: setups.id,
+      name: setups.name,
+      createdAt: setups.createdAt,
+      updatedAt: setups.updatedAt,
+      itemCount: sql<number>`COALESCE((
+        SELECT COUNT(*) FROM setup_items
+        WHERE setup_items.setup_id = setups.id
+      ), 0)`.as("item_count"),
+      totalWeight: sql<number>`COALESCE((
+        SELECT SUM(items.weight_grams) FROM setup_items
+        JOIN items ON items.id = setup_items.item_id
+        WHERE setup_items.setup_id = setups.id
+      ), 0)`.as("total_weight"),
+      totalCost: sql<number>`COALESCE((
+        SELECT SUM(items.price_cents) FROM setup_items
+        JOIN items ON items.id = setup_items.item_id
+        WHERE setup_items.setup_id = setups.id
+      ), 0)`.as("total_cost"),
+    })
+    .from(setups)
+    .all();
+}
+
+export function getSetupWithItems(db: Db = prodDb, setupId: number) {
+  const setup = db.select().from(setups)
+    .where(eq(setups.id, setupId)).get();
+  if (!setup) return null;
+
+  const itemList = db
+    .select({
+      id: items.id,
+      name: items.name,
+      weightGrams: items.weightGrams,
+      priceCents: items.priceCents,
+      categoryId: items.categoryId,
+      notes: items.notes,
+      productUrl: items.productUrl,
+      imageFilename: items.imageFilename,
+      createdAt: items.createdAt,
+      updatedAt: items.updatedAt,
+      categoryName: categories.name,
+      categoryEmoji: categories.emoji,
+    })
+    .from(setupItems)
+    .innerJoin(items, eq(setupItems.itemId, items.id))
+    .innerJoin(categories, eq(items.categoryId, categories.id))
+    .where(eq(setupItems.setupId, setupId))
+    .all();
+
+  return { ...setup, items: itemList };
+}
+
+export function updateSetup(db: Db = prodDb, setupId: number, data: UpdateSetup) {
+  const existing = db.select({ id: setups.id }).from(setups)
+    .where(eq(setups.id, setupId)).get();
+  if (!existing) return null;
+
+  return db
+    .update(setups)
+    .set({ name: data.name, updatedAt: new Date() })
+    .where(eq(setups.id, setupId))
+    .returning()
+    .get();
+}
+
+export function deleteSetup(db: Db = prodDb, setupId: number) {
+  const existing = db.select({ id: setups.id }).from(setups)
+    .where(eq(setups.id, setupId)).get();
+  if (!existing) return false;
+
+  db.delete(setups).where(eq(setups.id, setupId)).run();
+  return true;
+}
+
+export function syncSetupItems(db: Db = prodDb, setupId: number, itemIds: number[]) {
+  return db.transaction((tx) => {
+    // Delete all existing items for this setup
+    tx.delete(setupItems).where(eq(setupItems.setupId, setupId)).run();
+
+    // Re-insert new items
+    for (const itemId of itemIds) {
+      tx.insert(setupItems).values({ setupId, itemId }).run();
+    }
+  });
+}
+
+export function removeSetupItem(db: Db = prodDb, setupId: number, itemId: number) {
+  db.delete(setupItems)
+    .where(
+      sql`${setupItems.setupId} = ${setupId} AND ${setupItems.itemId} = ${itemId}`
+    )
+    .run();
+}