The sublining layer of the rheumatoid synovium has been examined in the electron microscope. In this layer lymphocytes appeared to leave the blood by passing through the endothelial cytoplasm of venules and veins to form dense perivascular accumulations rich in either lymphocytes, plasma cells or both. Undifferentiated blast cells and plasmablasts were also observed in these collections. The finding of predominantly lymphocytic accumulations around some vessels and predominantly plasma-cellrich accumulations in a similar distribution around others suggested that most of the lymphocytes were plasma cell precursors or B lymphocytes.The sublining and deeper layers of the rheumatoid synovial membrane contain large numbers of lymphocytes and plasma cells. These are distributed either diffusely or in nodular aggregates which are frequently located around small blood vessels (1). The origin of these cells and their role in the synovial immune response (2) have not been delineated. This communication describes the emigration of lymphocytes from the blood vessels of the rheumatoid synovium, their distribution in the synovial tissue and their ultrastructural characteristics. In addition, an attempt has been made to relate the cell types observed, i.e., lymphocytes, lymphoblasts, plasmablasts and plasma cells, to the under- lying mechanism of the rheumatoid synovial inflammatory reaction.
MATERIALS AND METHODSFifteen rheumatoid synovial membranes were obtained at synovectomy. All were from patients with definite or classical rheumatoid arthritis. Rheumatoid factor tests were positive in all cases. In the examination of individual synovial membranes blocks which did not show active infiltration were discarded. For electron microscopic examination, small pieces (2 cu mm) of tissue were fixed in 6% glutaraldehyde buffered with 0.05 M cacodylate, p H 7.3, for I hour. The pieces were washed several times in cacodylate buffer and postfixed with Palade's osmium tetroxide fixative (3) for 1 hour. The tissue was then dehydrated in a graded ethanol series, embedded in either Epon-Araldite resin mixture (4) or Araldite alone and sectioned on an LKB microtome. Sections were doubly stained with saturated aqueous uranyl acetate solution and lead citrate (5). Grids were examined with an RCA EMU-3 electron microscope. Thick sections were also stained with toluidine blue and observed in the light microscope.
RESULTS
Light Microscopic FindingsAbundant veins, venules and capillaries were seen in the sublining and deeper portions of the synovial membrane. Aggregations of lymphocytes were frequently observed in close relation-