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We have been followinl up a patient who presented a similar difficult diagnosis. A 59 year old woman was seen in 1983 complaining of a recurrent non-deforming, non-destructive arthritis since 1970. The sicca syndrome was obvious, with a Schirmer's test of 0, positive rose bengal staining, and keratoconjunctivitis. Antinuclear antibodies were not detected and latex agglutination was negative. Despite a normal erythrocyte sedimentation rate there were 20x 109 cells\/l (89% lymphocytes) in the synovial fluid of the left knee, and the synovial biopsy specimen was considered non-specific in spite of the presence of few epithelioid cells","author":"SIR","key":"ref_4","unstructured":"SIR, We were interested to read the case report by Melsom and coworkers.' We have been followinl up a patient who presented a similar difficult diagnosis. A 59 year old woman was seen in 1983 complaining of a recurrent non-deforming, non-destructive arthritis since 1970. The sicca syndrome was obvious, with a Schirmer's test of 0, positive rose bengal staining, and keratoconjunctivitis. Antinuclear antibodies were not detected and latex agglutination was negative. Despite a normal erythrocyte sedimentation rate there were 20x 109 cells\/l (89% lymphocytes) in the synovial fluid of the left knee, and the synovial biopsy specimen was considered non-specific in spite of the presence of few epithelioid cells."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1136\/ard.47.2.166","article-title":"Sarcoidosis in a patient presenting with clinical and histological features of primary Sj6gren's syndrome","volume":"47","author":"D, Melsom R.; M, Speight P.; J, Ryan; D, Perry J.","year":"1988","unstructured":"Melsom R D, Speight P M, Ryan J, Perry J D. Sarcoidosis in a patient presenting with clinical and histological features of primary Sj6gren's syndrome. 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