• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. Aug 1985; 44(8): 549–555.
PMCID: PMC1001700

Cellular immunohistopathology of acute, subacute, and chronic synovitis in rheumatoid arthritis.


Cellular inflammation in rheumatoid arthritis (RA) synovial membrane was studied in biopsy specimens taken at different stages of synovitis and disease. Patients were classified into three subgroups: acute RA, subacute RA, and chronic RA. Inflammatory cells were characterised by a histochemical esterase method and immunohistochemical peroxidase-antiperoxidase (PAP) and avidin-biotin-peroxidase (ABC) staining. The amounts and distribution of inflammatory cells were different in various stages of the synovitis. In acute onset RA monocytes and granulocytes predominated, suggesting that the beginning of rheumatoid inflammation is similar to inflammatory reaction in general. The presence of T cells and also of plasma cells in subacute RA suggests underlying subclinical changes also in apparently healthy joints in RA. The most typical feature of prolonged synovitis in chronic RA was its intensity, characterised by the presence of large T cell and plasma cell infiltrates. Our findings suggest that the immunological mechanisms are secondary to the tissue damage caused by the initial inflammatory events of unknown cause. However, the immunological mechanisms may still play a central role in the aetiopathogenesis, because findings in chronic RA suggest a defective down-regulation of the immune response.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.9M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Abrahamsen TG, Froland SS, Natvig JB, Pahle J. Elution and characterization of lymphocytes from rheumatoid inflammatory tissue. Scand J Immunol. 1975;4(8):823–830. [PubMed]
  • Førre O, Thoen J, Lea T, Dobloug JH, Mellbye OJ, Natvig JB, Pahle J, Solheim BG. In situ characterization of mononuclear cells in rheumatoid tissues, using monoclonal antibodies. No reduction of T8-positive cells or augmentation in T4-positive cells. Scand J Immunol. 1982 Oct;16(4):315–319. [PubMed]
  • Janossy G, Panayi G, Duke O, Bofill M, Poulter LW, Goldstein G. Rheumatoid arthritis: a disease of T-lymphocyte/macrophage immunoregulation. Lancet. 1981 Oct 17;2(8251):839–842. [PubMed]
  • Julkunen H. Synovial inflammatory cell reaction in chronic arthritis. Acta Rheumatol Scand. 1966;12(3):188–196. [PubMed]
  • Klareskog L, Forsum U, Wigren A, Wigzell H. Relationship between HLA-DR-expressing cells and T lymphocytes of different subsets in rheumatoid synovial tissue. Scand J Immunol. 1981 May;15(5):501–507. [PubMed]
  • Konttinen YT, Reitamo S, Ranki A, Häyry P, Kankaanapä U, Wegelius O. Characterization of the immunocompetent cells of rheumatoid synovium from tissue sections and eluates. Arthritis Rheum. 1981 Jan;24(1):71–79. [PubMed]
  • Van Boxel JA, Paget SA. Predominantly T-cell infiltrate in rheumatoid synovial membranes. N Engl J Med. 1975 Sep 11;293(11):517–520. [PubMed]
  • KULKA JP, BOCKING D, ROPES MW, BAUER W. Early joint lesions of rheumatoid arthritis; report of eight cases, with knee biopsies of lesions of less than one year's duration. AMA Arch Pathol. 1955 Feb;59(2):129–150. [PubMed]
  • Schumacher HR, Kitridou RC. Synovitis of recent onset. A clinicopathologic study during the first month of disease. Arthritis Rheum. 1972 Sep-Oct;15(5):465–485. [PubMed]
  • Konttinen YT, Bergroth V, Visa-Tolvanen K, Reitamo S, Förström L. Cellular infiltrate in situ and response kinetics of human intradermal and epicutaneous tuberculin reactions. Clin Immunol Immunopathol. 1983 Sep;28(3):441–449. [PubMed]
  • Graham RC, Jr, Karnovsky MJ. The early stages of absorption of injected horseradish peroxidase in the proximal tubules of mouse kidney: ultrastructural cytochemistry by a new technique. J Histochem Cytochem. 1966 Apr;14(4):291–302. [PubMed]
  • Hsu SM, Raine L, Fanger H. Use of avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem. 1981 Apr;29(4):577–580. [PubMed]
  • Peltola P. Effects of corticosteroid pulse therapy on inflammatory mechanisms. Scand J Rheumatol Suppl. 1984;54:10–12. [PubMed]
  • Ziff M. Phagocytes and substrates in the joint. Scand J Rheumatol Suppl. 1981;40:10–12. [PubMed]
  • Lindblad S, Klareskog L, Hedfors E, Forsum U, Sundström C. Phenotypic characterization of synovial tissue cells in situ in different types of synovitis. Arthritis Rheum. 1983 Nov;26(11):1321–1332. [PubMed]
  • Chattopadhyay C, Chattopadhyay H, Natvig JB, Mellbye OJ. Rheumatoid synovial lymphocytes lack concanavalin-A-activated suppressor cell activity. Scand J Immunol. 1979;10(5):479–486. [PubMed]
  • Chattopadhyay C, Chattopadhyay H, Natvig JB, Michaelsen TE, Mellbye OJ. Lack of suppressor cell activity in rheumatoid synovial lymphocytes. Scand J Immunol. 1979;10(4):309–316. [PubMed]
  • Konttinen YT, Bluestein HG, Zvaifler NJ. Regulation of the growth of Epstein-Barr virus-infected B cells. I. Growth regression by E rosetting cells from VCA-positive donors is a combined effect of autologous mixed leukocyte reaction and activation of T8+ memory cells. J Immunol. 1985 Apr;134(4):2287–2293. [PubMed]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...