Figure 1. Synovial Lining Hyperplasia. Section of a proliferative synovium from a patient with classic rheumatoid arthritis reveals synovial lining hyperplasia and a sublining lymphocyte infiltration and aggregation.
Figure 2. Erosion of Bone. At the junction between a proliferative inflamed rheumatoid synovium and the bone, scalloped regions of erosion can be seen (arrow). Section is stained with hematoxylin and eosin (bar scale = 100 µm).
Figure 3. Hand and Wrist in Rheumatoid Arthritis. The hand and wrist are common sites of synovitis in rheumatoid arthritis. Marked swelling in the wrist and metacarpophalangeal joints is caused by synovial proliferation. Modest ulnar deviation of the fingers is also present.
Figure 4. Rheumatoid Nodules. Rheumatoid nodules commonly form near the extensor surface of the elbow. They can be fixed to the underlying periosteum or can be freely mobile.
Figure 5. (A), Pelvic X-ray in Early Stage Disease. A pelvic roentgenogram of a patient with classic seropositive rheumatoid arthritis was taken early in the course of the disease. (B), Pelvic X-ray: Four Years Later. Another roentgenogram taken 4 years later demonstrates marked acetabular protrusion and resorption of the femoral heads, both of which are characteristic of the disease.
Figure 6. X-ray of Foot. Erosions (arrows) are visible in the metatarsal heads and in some of the phalanges in this roentgenogram of the foot of a patient with classic seropositive rheumatoid arthritis.
Figure 7. X-ray: Cervical Spine. The anterior edge of the odontoid process (O) is abnormally separated from the posterior margin of the arch of the atlas (A) in this lateral roentgenogram of the cervical spine of a patient with rheumatoid arthritis. Subluxations of the lower cervical vertebral bodies (arrows) are also visible.
Figure 8. Micrograph of Rheumatoid Nodule. A typical rheumatoid nodule contains an area of fibrinoid necrosis (center) surrounded by palisading histiocytes (arrows). At the periphery are round cells (predominantly lymphocytes). Stain is hematoxylin and eosin (bar scale = 300 µm).
Figure 9. Pharmacologic Management of Rheumatoid Arthritis. Proposed algorithm for pharmacologic management of rheumatoid arthritis. The solid lines indicate the standard management options, and the broken lines indicate stages at which adjunctive therapy may be introduced. Most patients require rapid advancement from nonsteroidal anti-inflammatory drugs to a second-line agent, most often methotrexate.