Massive extension of the suprapatellar pouch into the thigh tissues in rheumatoid disease.

SIR, A 74 year old woman presented to the outpatient department for routine review. She had had seropositive rheumatoid arthritis for two years and despite aggressive therapy with prednisolone and chlorambucil the disease was not yet under control. On this occasion she had active disease in most joints but particularly the knees. She had morning stiffness for three hours and her erythrocyte sedimentation rate was 54 mm/lst h. On further examination a cystic swelling measuring 20 cm x 5 cm was observed lying longitudinally in the deep tissues of the right thigh. A test for fluctuation hinted at a likely connection with the knee joint (Fig. 1).