Objective. To test the hypothesis that the proteinase cathepsin L is involved in the subchondral bone lesions found in chronic rheumatoid arthritis (RA).Methods. The medial tibia1 plateaus from 4 control cases and 30 patients diagnosed as having end-stage RA were examined immunochemically for cathepsin L.Results. RG lesions include large groups of mononuclear cells, many of which are rich in cathepsin L. Since these mononuclear cells contained the CD68 glycoprotein and, in the electron microscope, displayed an irregular cell surface, cytoplasmic vacuoles, lysosomes, and phagosomes, they were identified as belonging to the macrophage family. The lesions were classified into 2 main patterns, both displaying these cathepsin Grich cells, which, in at least 1 of the 2, were closely associated with bone degradation.Conclusion. The cathepsin L-rich macrophages are sufficiently numerous to be considered a major factor in producing the erosion of subchondral bone found in chronic RA lesions.Little is known of the cells involved in the resorption of subchondral bone that occurs in rheumatoid arthritis (RA), although there is some evidence that osteoclasts are responsible (1-3). There is general agreement that in healthy people, the degradation of bone is effected by osteoclasts through the secretion of cathepsin L and other proteinases into the acid-rich space that separates them from the bone (43). On the assumption Submitted for publication May 1, 1996; accepted in revised form September 30, 1996. that the same mechanism is operative in RA lesions, the expectation was that cathepsin L-producing osteoclasts would be observed in these lesions.In support of the potential role of cathepsin L in the resorption of bone and cartilage observed in RA patients, it is known that this enzyme degrades several bone components in vitro, namely, type I collagen (6) and the proteins osteonectin and osteocalcin (7), as well as components of cartilage, namely, type 11, IX, and XI collagens (6), the major proteoglycan, aggrecan (8), and link protein (9). Moreover, cathepsin L can be secreted outside the cell, as occurs in the course of antigen presentation (10) and in sperm maturation (11). Pathologic cells may also secrete large amounts of cathepsin L, as observed in cultures of malignantly transformed cells (12). Of particular interest is the evidence of cathepsin L secretion at sites of normal bone resorption (13-16), as well as elevated levels of cathepsin L in the synovial fluid of RA patients (17).The postulated role of osteoclasts in the production of RA lesions (1-3) implies that these cells synthesize and secrete cathepsin L and other proteinases for bone degradation. To find out whether osteoclasts or other cells are involved in the production of cathepsin L, we used an immunohistochemical approach. It was known that cathepsin L is synthesized as the 41-kd proteolytically inactive precursor procathepsin L, which in the acidic environment of the lysosome, gives rise to active forms of cathepsin L (18). We used an antibody raise...