housewife w'rth a 5 years history of ar­thritis and early morning stiffness of 3 - 4 hours . In March 1982 she was found to have active polyarthritis af­fecting mainly the hands, right wrist and right shoulder , and rheumatoid oedema of the feet. Her blood pres­sure was 140/80. ESR wes 65 mm in the first hour. Rheumatoid factor was positive in atitreof 1 :80. X-rays of the hands and feet showed periarticularosteoporosis and marginal erosions. A diagnosis of rheumatoid arthritis was made and she was treated with ketoprofen 100 mg twice daily. In May 1982 she suf­fered a severe exacerbation of her ar­thritis and at the same time developed sudden impairment of vision in the right eye so that she was able only to count fingers in the upper field. On general examination there were no nail fold lesions, skin rash, episcleritis or sub cutaneous nodules. Examination of the eyes : On the right side , the disc was not swollen but it was pale with very narrow ves­sels (Fig. 1} and there was an of affer­ent pupil defect. Examination of the asymptomatic left eye showed a normal disc (Fig. 2) and an appearance like a venous in-farct in the lower temporal quadrant