Rheumatoid granulomas may occur in classic systemic lupus erythematosus (SLE) as either an early or late manifestation of the disease. Nine patients had biopsy-proven granulomas, six in subcutaneous nodules of the elbow, two in synovial tissue, and one in the wall of a giant dissecting synovial cyst. Three patients had chronic deforming nonerosive polyarthritis characterized by extensive destruction of capsular tissues, ulnar deviation, and subluxation deformity of the postrheumatic fever or Jaccoud type. Rheumatoid granulomas were found in the synovium of the metacarpophalangeal joint in two of them and in a giant dissecting synovial cyst of the elbow in one. The occurrence of rheumatoid granulomas in both SLE and rheumatoid arthritis emphasizes the close association of the two disorders and that rheumatoid granulomas in adults are not unique to rheumatoid arthritis.