Since 1960 there have been several reports in the literature which stress the osseous changes in systemic lupus erythematosus. In 1960 Dubois and Cozen reported avascular necrosis of the femoral heads in 11 out of 400 cases (1). Most of the patients had been on steroids, and their average age was thirty-six years, with an equal sex ratio. There was an average five-year span between the lupus diagnosis and the onset of the avascular necrosis. Other authors have since reported similar findings in the head of the humerus (2–5). In addition to these findings, there are known arthritic changes of joint erosion, narrowing, and effusion with juxta-articular demineralization and subluxation, some of which are more consistent with rheumatoid arthritis than with systemic lupus erythematosus. In a disease in which the underlying pathologic process is vasculitis it would be logical to expect more generalized osseous involvement. Case Report J. C., a 28-year-old Negro male, presented himself on Sept. 18, 1959, with a chief complaint of shortness of breath and skin rash. Skin eruptions dated back to childhood when he received a diagnosis of atopic eczema. The arms and neck were involved recurrently. At the age of thirteen, the patient had contracted tuberculosis, for which he was hospitalized for two and a half years. One month prior to admission there developed shortness of breath and extension of the rash to the face. No definitive therapy had been administered for the dermatitis. At admission the blood pressure was 110∕80 and the pulse rate 116 per minute. He was well developed but emaciated. Atopic skin was seen with erythematous areas over the malar region of the face, the bridge of the nose, and the neck. There were confluent papillary lesions over the entire body. The heart showed enlargement to the anterior axillary line, and there was significant hepatomegaly. The chest film demonstrated bilateral apical fibrocalcific densities. Skin biopsy disclosed changes consistent with disseminated lupus erythematosus, and lupus erythematosus preparations were positive. The urinalysis showed 3+ albumin with 10 to 20 white blood cells and gross hematuria. The creatinine level was 0.52 mg per 100 cc. The venereal disease test was nonreactive, and the sickle-cell preparation was negative. The patient was placed on a program of isoniazid (INH) 300 mg a day, pyridoxine 50 mg t.i.d., prednisone 20 mg t.i.d., and hydrochlorothiazide (Esidrix) 50 mg a day. The prednisone was tapered to 15 mg a day and has been maintained until the present time. Since March 196O the patient has experienced intermittent bilateral ankle, heel, and knee pain and, in January 1967, bilateral hand and elbow pain. He has had intermittent ankle edema and effusion of the right knee. Radiographs of the elbows and knees in January 1967 were interpreted as osteoarthritis with multiple joint mice.