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The article features a letter on the management of sarcoidoisis-associated pulmonary hypertension (SAPH) and the author's response to it. The letter states that SAPH patients have had benefits and harms after pulmonary vasolidator initiation, and that outpatients require follow-up to assess possible drug harms. Also noted is the author's response that SAPH management needs further research although pulmonary vasolidators are effective in select patients.

In traditional teaching, synovial fluid cell counts over 50 000/mm 3 are in keeping with septic or crystalline arthritis. We report a patient with adult-onset Still's disease (AOSD) and associated inflammatory arthritis whose synovial fluid cell count was over 80 000/mm 3 This is the highest level reported in the literature, demonstrating that in the appropriate clinical context, markedly elevated synovial cell count levels over 50 000/mm 3 can be caused by inflammatory conditions like AOSD. Recognition of this is crucial to avoid inappropriate antibiotics and procedures while also ensuring correct immunosuppressive treatments are offered in a timely manner., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)