Three patients with pachydermoperiostosis are reported. All patients presented with moderate pain and swelling in multiple joints unresponsive to treatment, characteristic facial features which were marked in two cases, clubbing of nails and enlargement of distal parts of the extremities. One patient had spondylolisthesis of L5-S1 vertebrae, an association not previously described in this syndrome. The natural history of the disease is reviewed and the differential diagnosis is discussed.