A 39 year old woman consulted her GP because of bilateral pain in her knees.The knees appeared swollen.The joint space was markedly decreased.Knee replacement was done,and representative tissue removed during replacement surgery is shown in the accompanying photomicrograph.

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Rheumatoid arthritis often involves small joints,but can also involve the knees.The photomicrograph shows synovial hypertrophy,with a lymphoid infiltrate (a).On the right,erosion of the articular cartilage is seen,due to the so-called "pannus" formation,which acts like an abrasivE

A 39 Year Old Woman Consulted Her GP Because of Bilateral