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The clinical mangestations and pathol-Es describite le manifestationes clinic ogy of diffuse vascular lesions, occur-e le pathologia de diffuse lesiones vasring in three patients with rheumatoid cular, occurrente in tres patientes con arthritis, are described. The possible arthritis rheumatoide. Es discutite in significance of such lesions including detalio le signification possibile de tal their apparent relationship to cortico-lesiones, incluse lor apparente relation steroid therapy is discussed in detail. con therapia corticosteroide. HE OCCURRENCE of lesions of the small arteries and arterioles re-T sembling and sometimes indistinguishable from polyarteritis nodosa in patients with rheumatoid arthritis treated with adrenocortical steroids is being reported with increased frequency. In the past five years, 33 fatal cases (table 1) have shown at autopsy extensive arterial lesions which frequently were considered responsible for the fatal outcome. It is established that arteritis, sometimes of severe degree, occurs in association with rheumatoid arthritis in patients who have not received adrenocortical steroids. However, there appears to be an increase in the incidence of severe disseminated vascular lesions in this disease since the use of corticotropin and the corticosteroids in its treatment has become widespread. It is the purpose of this report to present three cases of malignant rheumatoid arthritis who received adrenocortical steroids and developed febrile polyneuropathy and gangrene of the extremities prior to death. In each of these cases extensive severe arteritis was found at autopsy. In addition, clinical observations of 14 patients with rheumatoid arthritis who developed peripheral neuropathy during or after administration of adrenocortical steroids are discussed. The literature concerning vascular lesions in rheumatoid arthritis is reviewed giving special attention to their relationships to adrenal corticosteroid and corticotropic hormone therapy. CASE HISTORIES AND SUMMARIES Three Cases with Autopsy FindingsDuring the period 1955-1957 manifestations of diffuse arteritis, proved at autopsy, were observed in three patients with progressive deforming rheiimatoid arthritis receiving adrenocortical. hormone therapy. These three pa-

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