The article by Dubois and Cozen in this issue of The Journal (p. 966) describing avascular bone necrosis, a new complication of systemic lupus erythematosus, serves to emphasize how greatly our concepts of the various forms of this disease have changed during the past twelve years since Hargraves described the lupus erythematosus cell test.1 The systemic type of the disease has emerged from a medical rarity to a relatively common disorder.
"Discoid" lupus erythematosus has been well known to the dermatologists for over a hundred years. With the aid of the L. E. test and careful clinical evaluation, it has been shown that transition forms occur between the so-called "localized discoid" form of the disease and the systemic phase. Such clinical manifestations in patients with discoid lupus as transitory arthralgia, mild rheumatoid-like arthritis, pleurisy, fever, Raynaud's phenomenon, and adenopathy are common findings. Leukopenia, elevated sedimentation rates, and increased serum