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In Reply.— 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

Cat-scratch disease is a zoonotic infection characterized by a skin papule at the site of the scratch followed by regional lymphadenitis. Recently, small gram-negative pleomorphic bacilli were demonstrated in sections of lymph node from patients with the disease. We now report identical bacteria in the primary inoculation site of three patients with cat-scratch disease. Lymph nodes from two of these patients also contained the same bacilli. Identical bacteria in both skin and lymph nodes from these patients are further evidence that the bacilli are the cause of cat-scratch disease. In early infections, biopsy of the primary site of inoculation and demonstration of bacilli may replace excision and histologic examination of lymph node in establishing the diagnosis of cat-scratch disease. (JAMA1984;252:928-931)

• A review of our experience with cicatricial pemphigoid revealed three patients with cicatricial pemphigoid and rheumatoid arthritis and one patient with ankylosing spondylitis who had a high titer of rheumatoid factor. A comparison of these four patients with patients who had bullous pemphigoid and rheumatoid arthritis shows similarities between cicatricial pemphigoid and bullous pemphigoid in relation to the development of rheumatoid arthritis. ( Arch Dermatol 114:415-417, 1978)