I read with interest the article by Hilling: “Recurrent Pneumothorax in a patient with Rheumatoid Arthritis and Leflunomide Treatment”, I wonder if this patient had Marfanoid habitus. Is well known (₁,₂) that patients with Marfan syndrome or with Joint Hypermobility Syndrome (JHS) with Marfanoid habitus, may develop spontaneous pneumothorax (SP).

In our paper to be presented in the Annual Arthritis Meeting (2007): “Clinical Study of 1124 Cases of Ehlers-Danlos Syndrome (Classic EDS, JHS and Vascular EDS)” We found SP in 2 patients with JHS and in 5 relatives of patients. We also found associated arthritis such as RA in 15% of JHS. Usually not even good rheumatologists do not diagnose JHS. Previously at EULAR (₃) we described Marfanoid habitus in 15.4% of 972 JHS cases.

Furthermore we have discussed a similar problem, in a letter to the Editor, regarding the occurrence of SP in 3 patients with ankylosing spondylitis (₄).