Histopathology: rheumatoidarthritis

These presentations are to help you identify, and to test yourself on identifying,basic histopathological features. They do not contain the additional factualinformation that you need to learn about these topics, or necessarily all the

images from resource sessions.This presentation contains images of basic histopathological features of

rheumatoid arthritis.Before viewing this presentation you are advised to review relevant histology,

relevant sections on chronic inflammation and healing and rheumatoidarthritis in a pathology textbook, relevant lecture notes, relevant sections of a

histopathology atlas and the histopathology power point presentations onchronic inflammation and healing.

Copyright University of Adelaide 2009

Rheumatoid arthritis. Macroscopic view of proliferative inflamed synovium forming villi within the jointspace.

Rheumatoid arthritis. Low power microscopic view of proliferative inflamed synovium forming villi (e.g. red stars)within the joint space. Darker areas within the villi and joint capsule represent areas of lymphocytes and plasmacells. These appear dark on low power due to their relatively high nuclear:cytoplasmic ratios, thus the blue of thehaematoxylin staining the nucleus predominates over the eosinophilic cytoplasm. A few germinal centres are alsoseen (yellow arrows), as is some fibrin (black star) within the joint space.

Joint capsule

Rheumatoid arthritis. High power view of lymphocytes (e.g. yellow arrows) and plasma cells (e.g. redarrows) within the synovium. Blue arrows: synoviocytes

Rheumatoid arthritis, medium power view of inflamed synovium showing a germinal centre (outlined in yellow)surrounded by predominantly B lymphocytes. The germinal centre appears paler than the surrounding lymphocytes asduring differentiation into plasma cells, the lymphocytes within the germinal centre develop larger paler nuclei andmore cytoplasm. Many plasma cells are also present in the surrounding tissues (e.g. red arrows).

Rheumatoid arthritis, high power view of actively inflamed synovium. Surface synovium is indicated by black arrows,plasma cells by yellow arrows and neutrophils by red arrows. Capillaries containing red blood cells (here appearingorange) can also be seen. Note that the endothelial cell nuclei (blue arrows) are quite plump rather than flattened, areactive change related to inflammation.

Rheumatoid arthritis. Medium power view of pannus (P) eroding into cartilage (C). (from Wheater’s BasicHistopathology. Stevens, Lowe and Young, 4th ed. Churchill Livingstone).

Rheumatoid arthritis. High power view of pannus (P) eroding into bone (B).

P

P

P B

Subcutaneous rheumatoid nodule with an area of necrosis (red stars) surrounded by a palisade ofmacrophages and scattered chronic inflammatory cells.

Low power

High power

Usual interstitial pneumonia. Fibroblastic focus with chronic inflammatory cell infiltrate in the pulmonary interstitium.This may develop in patients with rheumatoid arthritis. From Robbins and Cotran Pathologic Basis of Disease. 7th ed.Elsevier Saunders.