[Vasculitis with anemia infarcts of the villi of the synovial membrane in rheumatoid arthritis].

The observation of partial or total necrotic synovial villi in cases of rheumatoid arthritis was the occasion to examine if these necroses are caused by an obturated vasculitis and can be interpreted therefore as anemic infarcts. We have investigated 415 synovial membranes of 200 patients with rheumatoid arthritis. 5% of the synovial membranes in 10% of the patients showed infarcts of villi with necrotizing thrombovasculitis of the main artery or several vessels at the basis of villi. The infarcts were frequently localized at the hand (12.5%) and elbow (10.5%) joints. The infarcts of villi have a relation to the local histologic activity of the synovialitis. Only synovial membranes with high and middle activity show corresponding findings. There was no syntropy with rheumatoid granulomas. Because necroses of villi without vasculitis are also seen, it remains to be answered if these are caused by a provable vasculitis, or by another pathogenesis. The fate of the infarcts is different--some enter the joints as "rice bodies", others organize from a basis of villi. The infarcts of villi are expressions of a severe local disturbance of circulation. They are able to potentiate the local activity and the progress of synovialitis.