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    Subjects/Pathology/Rheumatoid Pannus — Inflamed Joint Synovium
    Rheumatoid Pannus — Inflamed Joint Synovium
    medium
    microscope Pathology

    A 45-year-old woman presents with a 4-month history of symmetric polyarthritis affecting her metacarpophalangeal and proximal interphalangeal joints, with morning stiffness lasting 2 hours. Clinical examination reveals joint swelling, warmth, and tenderness. X-ray of the hands shows juxta-articular osteopenia and early marginal erosions. Serology is positive for anti-CCP antibodies and rheumatoid factor. On histopathology of synovial tissue obtained during arthroscopy, the structure marked **B** in the diagram—pannus tissue eroding cartilage and bone—is identified as the primary pathologic driver of joint destruction. Which of the following best describes the mechanism by which this structure causes irreversible joint damage in rheumatoid arthritis?

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