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suffering from rheumatoid arthritis, affecting the wrists and hands. This increased in severity involving elbows, shoulders, neck, hips, knees, and ankles; the patient had been bed-ridden since 1940.He was admitted to hospital in 1958 with a history of a painless lump in the left tibia for one month. X-ray examination revealed cystic swellings in the left tibia and lateral condyle of the femur, which did not communicate with the knee joint. At operation a thick-walled cavity was found containing brown inspissated material, in the antero-medial border of the tibia. A wedge of cortex was removed; following the histological report (vide infra S58/1161) he was given deep x-ray therapy to the bone.While still in hospital the patient fractured the left tibia at the operation site. The fracture united uneventfully but the cystic changes remained.Received for publication 7 September 1965. In 1958 an ischaemic ulcer appeared on the left little to. and in 1959 he developed an ulcer on the left third toe which extended on to the sole. He was readmitted in 1961 as the condition of the toes and sole of the foot had got worse and the peripheral circulation was now very poor. A below-knee amputation was done and postoperative recovery was uneventful. Later, in 1961, an ulcer appeared on the second toe of the right foot and shortly afterwards the right leg was removed below the knee. At this time he was found to have diabetes mellitus which was treated with insulin, tolbutamide, and later by diet alone.In 1962 the left amputation stump discharged yellow material, which was not examined by the laboratory, and an above-knee amputation was done. After the operation he developed a sacral bed-sore which healed slowly but the amputation site continued to discharge; this led to a further shortening of the bone. Eventually the bed-sore and the amputation site healed and he was discharged from hospital. He had since been seen as an out-patient and although he was admitted in February 1963 (with a chest infection) and in July 1963 (with glaucoma), he had no further trouble with the bones; however the cystic changes persisted in those bones in which they were originally seen. A resume of radiological findings is as follows:-A destructive arthritis of the rheumatoid type, involving both wrists and elbows, was the first abnormality found in 1950. Eight years later when the patient presented with a cystic swelling over the upper end of the left tibia a skeletal survey was done. In addition to advanced arthritis of rheumatoid type involving many joints, the most extensive long-bone change was in the upper 19 cm. of the left tibia. The bone was expanded, the cortex was thinned, and the trabeculae were replaced by a 'basket' pattern (Fig. 1); a pathological fracture later occurred here. Similar cystic changes involved the lower ends of both femora, the upper end of the right tibia, and also the left patella (Fig. 2). These lesions were, however, much smaller than that of the left tibia.Extensive atheromatous calcification was seen in femoral...