Atypical incudomalleal and incudostapedial joint changes were found in a 55-year-old woman with long-standing rheumatoid arthritis and sicca syndrome (Sjögren syndrome). Available audiograms taken at 37 and 42 years of age demonstrated slight bilateral high-frequency loss of hearing. The ossicular joint changes involved dissolution of disk material together with proliferation of synovial-type elements of the disk and articular surfaces, with formation of pannus-like tissue. There was extensive destruction of cartilage, with cellular collagenous tissue extending along the exposed bone surfaces. Despite strong similarities to rheumatoid arthritis, a definite diagnosis cannot be made in the absence of the inflammatory, lymphocyteplasma cell component.
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