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As the rheumatoid process progresses, inflammatory cells in the synovial fluid grow and form a mass known as pannus , which invades and destroys soft tissue, cartilage, and bone.
The pannus and the cells within it are responsible for the periarticular bony erosions in the bare areas.
As the pannus erodes the bone, it will also degenerate the alar check ligaments which stabilize C1.
Joint destruction occurs with erosion of juxtaarticular bone around the margins of pannus and invasion of subchondral tissue by pannus .
The large pannus predisposes patients to fluid accumulation, creating an environment conducive to seroma formation, infection, and wound edge separation or dehiscence.
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