Immunocytology in arthritic joints.

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Abstract
The functional state of exudative leucocytes obtained from patients with inflammatory joint disease was evaluated with the aid of 5 immunofluorescent tools. Neutrophils were the predominant cell type in these exudates. Phagocytosis was prominent with material related to either albumin or fibrin usually widely distributed within the cytoplasm as fine granular inclusions. Neutrophils from patients with rheumatoid arthritis were frequently choked with massive intracellular inclusions which were identified immunologically as related to either IgG, IgM, or fibrin. Degranulation of these neutrophils was associated with reduction in intracellular cathepsin. Protein particulates were abundant in many of the inflammatory exudates. Aggregates identified as IgG and IgM were limited to patients with rheumatoid arthritis. Strands and amorphous masses of fibrin as well as albumin-related materials were found in most exudates. Cathepsin was occassionally present as large extracellular particulates, but ordinarily as fine granules through the exudate. Cathepsin was identified with an immunofluorescent marker. Neutrophils contained the greatest concentration of cathepsin and the distribution was either as small granules (similar in size to the specific neutrophil granules) or as large masses at the edge or in phagosomes. The blood neutrophils of patients with rheumatoid arthritis contained a good supply of cathepsin, although many of the synovial fluid neutrophils appeared deficient in cathepsin. Such deficiency, as well as finding extracellular cathepsin, confirmed cathepsin release from neutrophilic lysosomes in the course of inflammatory joint disease.