A case of rheumatoid nodulosis and the difficulties encountered in its diagnosis are presented. A positive rheumatoid factor, biopsy proved involvement of the synovium and bone at the second metacarpophalangeal joint, and regression of nodules and mild arthritic symptoms with gold therapy, supported the diagnosis of a rheumatoid disease variant. The relationship of the disease to rheumatoid arthritis, gout, and xanthomatosis is discussed.