To the Editor.—
We noted with interest the report by Goldenberg and Gibbons (235:284, 1976) of seropositive rheumatoid arthritis and HLA 27. We would interpret the clinical and laboratory studies to indicate that the patient had inflammatory bowel disease with spondylitis, and that rheumatoid arthritis subsequently developed. While it is unusual to see seropositive rheumatoid disease with nodules and few articular findings, such cases have been described.1We have recently seen a 44-year-old man with a history of Reiter syndrome diagnosed in 1961. In June 1975, he had asymmetric, painful swelling involving the wrists and the metacarpophalangeal and proximal interphalangeal joints. The patient was initially thought to have an exacerbation of Reiter syndrome, although there were no genitourinary, mucocutaneous, or ocular manifestations. He had positive reactions for HLA W27 (B27 according to the newer nomenclature), and his latex test for rheumatoid factor was positive in a dilution of 1:1,280.