I must disagree with Dr Callen with regard to the diagnosis of rheumatoid arthritis in three of the four patients in our recent report. On the basis of history, clinical findings, and laboratory and roentgenographic data, the three cases fit the criteria for definite rheumatoid arthritis.1 Callen implies in his letter that because only two of the four patients had a positive rheumatoid factor, a diagnosis of rheumatoid arthritis can not be made. He does not seem to take into consideration the other data provided. I am sure that I do not need to point out that a positive rheumatoid factor is only one of 11 criteria used to make the diagnosis in the ARA's list. In addition, the fourth patient, who also happened to have a positive rheumatoid factor, did not have rheumatoid arthritis. He had ankylosing spondylitis as well, and this is clearly stated in
Spigel GT. Association of Cicatricial Pemphigoid and Rheumatoid Arthritis-Reply. Arch Dermatol. 1979;115(1):108–109. doi:https://doi.org/10.1001/archderm.1979.04010010074034
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