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Obliterative endarteritis affecting digital and visceral vessels in rheumatoid arthritis was first described in detail by Bywaters (1957), although Kestler (1949) and Cruickshank (1954) had previously referred to a subacute endarteritis in this disease. The relationship between this form of arterial lesion and the necrotizing arteritis sometimes occurring in rheumatoid disease (Ball, 1954) remains unexplained, although it has been noted by Bywaters (1957) and by Sokoloff and Bunim (1957) that both arterial lesions may occur in the same individual. Histologically, the obliterative endarteritis of digital vessels in patients with rheumatoid arthritis is characterized by a more or less concentric increase of intimal fibrous tissue, largely free of inflammatory cells. The internal elastic lamina usually remains intact, although when intimal thickening is marked there may be splitting of elastic fibres and thrombosis with resultant occlusion of the artery. Clinically, the condition is often asymptomatic, although cold digits, Raynaud's phenomenon, and ischaemic lesions in the form of nail-fold and fingerpulp thrombosis may be encountered. Brachial angiography has been used to study the digital arteries of rheumatoid patients by Scott, Hourihane, Doyle, Steiner, Laws, Dixon, and Bywaters (1961) and by Laws, Lillie, and Scott (1963). These workers found that the digital vessels frequently showed narrowing or complete occlusion. They also pointed out that nearly all patients showing these lesions had positive serum titres for rheumatoid factor. In the present study immunofluorescent methods have been used to determine whether rheumatoid factor is present within the intimal lesion of digital arteries from patients with rheumatoid arthritis. Materials

The Digital Artery Lesion of Rheumatoid Arthritis: AN IMMUNOFLUORESCENT STUDY