Some humoral immunological aspects of the rheumatoid arthritis correlated with the ultrastructural changes of the rheumatoid synovial fluid.

We performed serologic and synovial investigations in rheumatoid (Latex 1/1280, 1/640, negative and Waaler Rose 1/1024, 1/512, negative), non-rheumatoid and control lots. The immunological results were correlated with ultrastructural changes found in the synovial fluid (SF) at the same titres of rheumatoid factor (RF). The pathologic values of the circulating immune complexes (CIC) (mean = 108.05 U), IgM (mean = 420 UI/ml), IgG (mean = 355.36 UI/ml), and anti-collagen II antibodies (mean = 558.6 U) were present at high titres of RF (Latex 1/1280, Waaler Rose 1/1024). These cases had also major ultrastructural changes of the nucleus and cytoplasm. We inferred from this the implication of the immune factors in the etiology and pathology of the Rheumatoid Arthritis (RA). The high, titres of RF were correlated with pathologic values of the C-reactive-protein (CRP) (mean = 13.31 mg%) and alpha-1-acid glycoprotein (A-1-GA) (mean = 158.3 mg%). The decline of the complement fraction C3 from the synovial fluid in RA confirms the immune character of the rheumatoid synovitis and may be useful in the diagnosis process. The significantly lower concentrations of the protease inhibitors alpha-1-anti-trypsin (A-1-AT) (mean = 165.1 mg%) and alpha-2-macroglobulin (A-2-M) (mean = 129.6 mg%) in synovial fluid suggest a diminution of the anti-proteasic activity due to local immune conflict.

Cytomorphological, ultrastructural and immunological particularities of the synovial fluid in seronegative rheumatoid arthritis.

Our studies on the cytomorphological and ultrastructural analysis of 15 Synovial Fluid (SF) samples from patients diagnosed with seronegative Rheumatoid Arthritis (RA) and 10 SF from patients with Hydroarthrosis considered as controls were carried out. By cytomorphological studies we determined the cellularity, ragocytosis and synoviocytogram. SF in seronegative RA is characterized by leucocytosis (7,656/mm3) with polynucleosis (65.38%) and ragocytosis (59.27%) versus hydroarthrosis SF defined morphologically by lymphocytosis (47%). Degenerative forms of ragocyte-like polymorphonuclears (PMN) cells, individualized by an ultrastructural alteration less evident than recorded in seropositive Rheumatoid Arthritis (RA), associated with a remarkable capacity of endocytosis. The ultrastructural alterations, immune complexes (CIC), the immunoglobulins (MG) and the anticollagen II antibodies, suggest the early implication of these immune parameters in etiopathogenesis. The corroboration of the cytomorphological, ultrastructural and immunological data allows the profound study of the etiopathogenic mechanism and may represent a paraclinical criterion for differentiated seronegative RA field.

An ultrastructural study of the synovial fluid (S.F.) in rheumatoid arthritis versus ankylotic spondylarthritis.

Our studies focused on the cytomorphological and ultrastructural analysis of ten synovial fluid (S.F.) samples from patients with serum positive rheumatoid arthritis (R.A.) (latex 1/1280, 1/640 and Waaler-Rose 1/1024, 1/1512) as compared to five S.F. sampes from patients with peripheral ankylotic spondylarthritis (A.S.). The cytomorphological investigation aimed at defining the cellularity, ragocytosis and synoviocytogram. We found out that the average number of cells (R.A. = 8060/mm3; A.S. = 6100/mm3), percentage of ragocytes (R.A. = 75%; A.S. = 25%), polymorphonuclear cells (R.A. = 70%; A.S. = 58%), degradative polymorphonuclear cells (R.A. = 7%, A.S. = 3%) and phagocytic mononuclear cells (R.A. = 16%; A.S. = 13%) are by far larger in R.A. than in A.S., whereas the lymphocyte percentage is much more reduced (R.A. = 13%; A.S. = 26%). Ultrastructurally, the rheumatoid S.F. ragocytes present specific intracytoplasmic inclusions and phagolysosomes pointing to an endocytotic activity. At the level of the degradative polymorphonuclear cells (7% cytomorphologically confirmed), the alteration of the granular-fibrillar structure of the nucleus and the presence of some cytoplasmic lysis areas were associated with the absence of cellular organelles. We also noticed cellular and collagen detritus. In A.S. the ultrastructural effect on the polymorphonuclear cells is much more reduced (3%) as compared to R.A. and resides in the dilatation of both mitochondrial cristae and granularendoreticular cisternae as well as in a slight concentration of the fibrogranular nuclear matter. The cells are considerably active in endocytosis. The phagocytotic mononuclear cells of the rheumatoid S.F. and A.S. are morphologically identical to the immunologically activated macrophages.(ABSTRACT TRUNCATED AT 250 WORDS)