Case 66: Rheumatoid arthritis

This 62 year old female was admitted to hospital with severe shortness of breath and died several hours later. An autopsy revealed a recent myocardial infarct, massive pulmonary embolism and rheumatoid arthritis which was most marked in the fingers of the right hand.

Macroscopic pathology

Microscopic pathology

Macroscopic examination of this slide shows an irregular arrangement of eosinophilic papillary structures with a thin covering of basophilic tissue.

Microscopic examination of the slide shows finger-like protrusions of inflamed and oedematous fibrovascular stroma covered by plump epithelial cells (1), (2) that are focally multilayered. Fragments of fibrin are also present. This synovial tissue shows all the salient features of rheumatoid arthritis:

1) Villous hypertrophy of synovium
2) Hyperplasia of synoviocytes
3) Chronic inflammation, plasma cells, lymphocytes (2), (3), (4) and lymphoid follicles (1), (4). in the microscopic description here

Normal bone & soft tissue tissues

Click on any hyperlink text in the slide description above to take you to a microscopic view that illustrates the point. The picture will be resized to fill your screen. You can then enlarge the picture to full size by clicking anywhere within it. Or you can click on one of the pictures below for the same result. Press the left browser arrow to return here. Where there are numbers in brackets, these refer to the numbers of the pictures below.

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Test yourself on the pictures of this case - Link to the bone and soft tissue test pictures

Commentary

Rheumatoid arthritis is essentially a severe form of chronic synovitis, but as the disease progresses, periarticular soft tissue oedema and inflammation may occur and this causes the fusiform swelling around the joint.
The exuberant inflammatory tissue which forms in the joints and causes much of the swelling is known as pannus. Pannus eventually covers the articular surfaces of the joints involved and, by release of enzymes and mediators, destroys the underlying bone and cartilage.

Learning objectives

1. Recognise the histological changes of rheumatoid arthritis
2. Identify the inflammatory cell types seen in this disease