A 45-year-old woman with a 2-year history of increasing unsteadiness was referred from neurology to the rheumatology department. She had a 10-year history of chronic fatigue, arthralgia, and myalgia. She had a history of photosensitive rash. She had stopped wearing contact lenses in her early twenties because of symptomatic dry eyes, carried a water bottle with her to work, and had a constant irritating dry cough. She had two healthy children. One baby had had a transient neonatal rash. Her sister had autoimmune thyroid disease.

A 45-year-old woman with a 2-year history of increasing unsteadiness was referred from neurology to the rheumatology department. She had a 10-year history of chronic fatigue, arthralgia, and myalgia. She had a history of photosensitive rash. She had stopped wearing contact lenses in her early twenties because of symptomatic dry eyes, carried a water bottle with her to work, and had a constant irritating dry cough. She had two healthy children. One baby had had a transient neonatal rash. Her sister had autoimmune thyroid disease.