Rheumatoid disease may take many forms, and at times degeneration may be quite out of proportion to the other features. Sometimes a quiet atrophy of bone may lead to "main-en-lorgnette" and at other times tendon atrophy may cause rupture (Kersley 1948, Harris 1951). In a third type degeneration may be associated with proliferation and the formation of multiple nodules which break down and ulcerate. In one such case recently observed, hydrocortisone applied locally on a dressing, with continuation of antibiotics that had previously been in use, caused temporary healing. Three cases have been investigated in which massive cysts filled with pus-like material were found. When first seen, the destruction was such that the differential diagnosis of a tuberculous abscess or a breaking-down sarcoma was suggested. Four examples of necrosis of 238 THE JOURNAL OF BONE AND JOINT SURGERY CASE REPORTS Case 1-A man aged forty-five, whose brother had severe rheumatoid arthritis, developed typical arthritis after a quinsy. Two years later he was treated with gold, which produced a rash. In the next year his left knee first became swollen. When he the usual picture of advanced rheumatoid disease. the American Rheumatism Association.

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