The pathogenesis of articular (1-7), tenosynovial (4,8), and bursal (2,4,6,8-10) chyliform effusions in rheumatoid arthritis (RA) is unknown. This report describes the histologic and histochemical findings from the walls of 5 RA olecranon bursae filled with chyliform effusions. The results obtained suggest that rheumatoid nodules have a role in the pathogenesis of these effusions.
PATIENTS AND METHODS
All reagents were high purity commercial samples from Merck, Sigma, and Calbiochem-Behring Corporation.
Six olecranon bursae were removed from each of 4 patients with classic RA (11). All contained synovial fluid which was analyzed according to standard techniques described by Cohen and Brandt (12). In 5 instances, the synovial fluid appeared chylous and contained many rhomboidal and acicular crystals.
Serum and synovial fluid concentrations of total, free, and estenfied cholesterol, triglycerides, phospholipids, and A and B apolipoproteins were measured in all patients according to published procedures (13-19). To assess the crystallographic and chemical properties of crystals purified from synovial fluids (1,2), we performed x-ray diffractometric (1,20),