A 40 year old woman has severe, disabling rheumatoid ahritis. Rheumatoid factor is positive. What would a biopsy of the synovium of her knee most likely reveal?
Severe rheumatoid ahritis causes a proliferative synovitis with extensive damage to the synovium of the joint. The synol membrane becomes markedly thickened (pannus formation), with edematous villous projections that extend into the joint space. The intense inflammatory infiltrate that is present is typically composed of plasma cells, lymphocytes, and macrophages. Ref: Bednar M.S., Light T.R. (2006). Chapter 10. Hand Surgery. In H.B. Skinner (Ed), CURRENT Diagnosis & Treatment in Ohopedics, 4e.
A nearly normal synovium with scattered inflammatory cells
A non-proliferative synovitis with abscess formation
A non-proliferative synovitis with many neutrophils
A proliferative synovitis with many lymphocytes, macrophages, and plasma cells