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Pathology Group 6
Rheumatoid Arthritis
Morphological and
Histopathological
Findings
Histology
Robbins’ Green Box
Pannus
• Mass of
a) edematous synovium
b) inflammatory cells
c) granulation tissue
d) fibroblasts
• Grows over and erodes articular cartilage
• Then, pannus bridges the apposing bones= fibrous ankylosis
• fibrous ankylosis ossifies  bone fusion = bony ankylosis.
Histogenesis of rheumatoid arthritis
Rubin’s Pathology
1. Virus or
2. unknown stress
Stimulate the synovial cells to proliferate.
Histogenesis of rheumatoid arthritis
Rubin’s Pathology
The influx of
1. Lymphocytes
2. plasma cells
3. mast cells and
4. neovascularization
5. Edema
=hypertrophy and hyperplasia of the synovium.
Histogenesis of rheumatoid arthritis
Rubin’s Pathology
Prominent lymphoid nodules
Histogenesis of rheumatoid arthritis
Rubin’s Pathology
Synovium
1. Extends to--joint space- bone
2. covers the cartilage as a pannus.
3. No synovial fluid = Articular cartilage
destroyed
Histogenesis of rheumatoid arthritis
Rubin’s Pathology
Joint is destroyed and fused
= Ankylosis.
Histology
Robbins’ Green Box
Characteristic histologic features
• Synovial cell hyperplasia  Proliferation
• Inflammatory infiltrates forming lymphoid follicles
[Helper T , B , dendritic, plasma cells, macrophages]
• Angiogenesis;
• Fibrinopurulent exudate
• Osteoclastic activity in subchondral bone,
Morphology
•Synovium becomes grossly edematous.
•Covered by delicate and bulbous villi.
Robbins’ Green Box
Morphology
Morphology : Biopsy
Robbins’ Green Box
It’s All About
Visual Treat
Now…..
Morphology
Hyperplastic synovium
• Finger-like projections
• Areas of fibrin deposition
Rubin’s Pathology
Histology
Robbins
Histology
Rubin’s Pathology
Synovium
• Lymphoid follicles
(Allison-Ghormley
bodies)
• villous folds
Histology
Rubin’s Pathology
Synovium
• giant cells
Histology
Kaplan Step1 2020
Rheumatoid Nodules
Rubin’s Pathology
• Infrequent
• Typically occur in the subcutaneous tissue of the forearm, elbows, occiput, and
lumbosacral area.
• Firm
• Nontender
• Round to oval.
Rheumatoid nodules
Robbins’ Green Box
Rheumatoid nodules
Histology: Rheumatoid Nodule
Robbins’ Green Box
• Resemble necrotizing
granulomas
• Central zone of fibrinoid necrosis
• Rim of activated macrophages +
lymphocytes + plasma cells
Histology: Rheumatoid Nodule
Rubin’s Pathology
Thank You
Spare Slides
Morphology
Kaplan Step1 2020
Joint deformities can include:
• Radial deviation of the wrist and ulnar
deviation of the fingers
• Swan neck deformity (hyperextension of
PIP joint and flexion of DIP joint)
• Boutonniere deformity (flexion of PIP
and extension of DIP joints)
• Baker cysts (synovial cysts in the
popliteal fossa) may be present
Morphology
Rubin’s Pathology
Morphology
Figure 26.45 Rheumatoid
arthritis of the hand.
Characteristic features include
diffuse osteopenia, periarticular
bony erosions, and marked loss
of the joint spaces of the carpal,
metacarpal, phalangeal, and
interphalangeal joints.
Robbins

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Histopathology of Rheumatoid Arthritis: Visual treat