102synovial thickening and tenderness of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. The MCP joints were subluxed, and there was early PIP joint hyperextension change. The feet showed bilateral hallux valgus deformities with subluxation of the lateral metatarsophalangeal joints. Tests for antinuclear antibody and rheumatoid factor were nonreactive; the serologic test for syphilis was negative.Nasal septal perforation has been described in systemic lupus erythematosus (2,3) and in a variety of nongranulomatous rheumatic diseases (4). In none of these reports is there specific documentation of an associated saddle nose deformity. In the patients with rheumatoid arthritis described by Willkens et a1 (4), many had Raynaud's phenomenon and high titers of rheumatoid factor. They speculated that septal perforation might be due to vasculitis, increased blood viscosity, or immune complex deposition. Our patient was seronegative and did not have Raynaud's phenomenon. She did have Sjogren's syndrome, and dryness of the nasal mucosa may have contributed to the septal perforation.Approximately 30% of patients with RP have a preceding or coexistent rheumatic disease (5). Without biopsy of the nasal mucosa and cartilage, we could not be absolutely certain that our patient did not have RP. However, it would be unusual to have an isolated episode of nasal chondritis due to RP with no additional features over a 13-year period. Our patient's joint examination was clearly inconsistent with the arthropathy of RP which is typically episodic, asymmetric, nonerosive, and nondeforming (6).Saddle nose deformity may be yet another extraarticular manifestation of rheumatoid disease. REFERENCES 1. DeWeese DD, Saunders WH: Textbook of Otolaryngology. St. Louis, CV Mosby, 1977, pp 21 1-2 13 2. Alcalh H, Alarc6n-Segovia D: Ulceration and perforation of the nasal septum in systemic lupus erythematosus. N Engl J Med
