The Nuu-Chah-Nulth are a tribe of 2,300 Pacific Northwest native Indians. A retrospective study has identified 157 requiring referral to rheumatologists over 15 years. Rheumatoid arthritis (RA) was found in 23, systemic lupus erythematosus (SLE) in 8, sacroiliitis 5, and Reiter's syndrome 1. Overlap syndromes with combinations of RA, SLE, scleroderma and polymyositis were seen in 9. Other rheumatic disorders included osteoarthritis 10, soft tissue rheumatism 14, and musculoskeletal complaints of known etiology (trauma, infection, neoplasm) 12. The remaining 75 patients suffered from periodic weather dependent joint swelling (52) or polyarthralgia (23) which were sometimes accompanied by features of systemic connective tissue disease. These findings are compared with rheumatic disease in other North American Indians.