Atorvastatine for chronic synovitis due to massive intra-articular cholesterol monohydrate deposition in long-standing rheumatoid arthritis.

delay the diagnosis and treatment [2, 3, 9]. The audiovestibular prognosis depends on steroid treatment within the first month of the symptoms [3], but hearing loss may progress to profound bilateral deafness if the patient has repeated attacks [3–5]. Our patient’s initial ocular symptoms occurred 4 yrs before her hearing loss. This was the clue leading to diagnosis and appropriate treatment with corticosteroids, for the acute episode, and immunomodulation to maintain the success. Although 37% of patients with atypical Cogan’s syndrome progress to bilateral deafness [2], despite systemic corticosteroids and immunomodulation, our patient’s auditory acuity remained stable after a 2-yr treatment with corticosteroids, methotrexate and ciclosporin. In addition, systemic treatment did not modify the prognosis of the keratopathy due to her advanced initial presentation. Severe keratopathy can be the end-stage of corneal compromise in Cogan’s syndrome and may present in childhood as the main manifestation. A multi-disciplinary approach is necessary to be successful at early diagnosis and treatment.