Pathways to chronic inflammation in rheumatoid synovitis

Postcapillary venules resembling the high endothelial venules (HEVs) of lymphoid tissues have often been observed at sites of chronic inflammation. We have therefore postulated that such venules may be an important site of lymphocyte migration into rheumatoid synovial membrane and that inflammatory cell products may act on endothelial cells (ECs) to increase lymphocyte emigration. Electron microscopic examination of rheumatoid synovial membranes showed that a strong correlation existed between the proportion of lymphocytes in perivascular tissue and the height/base ratio of the ECs in those areas. In addition, binding experiments showed that peripheral blood mononuclear cells preferentially bound to ECs in sections of rheumatoid synovial membrane that had the morphological appearance of HEVs. In vitro binding experiments, in which lymphocyte adhesion to human umbilical vein EC monolayers was measured, showed that adhesion was enhanced by preincubation of the ECs with interferon-gamma or interleukin 1 (IL 1). The central role of IL 1 in increasing lymphocyte migration into the rheumatoid synovial membrane was also supported by the findings that IL 1 is chemotactic for lymphocytes, ECs can secrete IL 1, and IL 1 activity is readily detectable in synovial fluids of rheumatoid arthritis patients.