Objective. In vitro, activated neutrophils create a microenvironment in which proteinase inhibitors are inactivated through the coordinate action of reactive oxygen species and released elastase. We investigated whether such a mechanism may contribute to the destruction of the joint tissues in arthritis.Methods. We analyzed the state of a,-antitrypsin (a,AT) and a,-antichymotrypsin (a,ACT), the two major inhibitors of the neutrophilic serine proteinases, in synovial fluid (SF) from patients with inflammatory arthropathies (n = 71) and osteoarthritis (OA) (n = ll), and related the results to neutrophil activation in SF.Results. The ratio of functional to antigenic levels of q A T in SF of patients with inflammatory joint diseases was similar to that of alAT in normal plasma, whereas that of a,ACT was significantly decreased. Patients with inflammatory arthropathies had significantly higher levels of inactivated a,AT (ialAT) and inactivated a,ACT (ia,ACT) in SF (as determined with monoclonal antibodies specific for the inactivated [i.e., proteolytically inactivated and/or complexed] forms of these inhibitors) than patients with OA (P < 0.005).Inactivated a,AT and ia,ACT levels corresponded to 0.341% and 3-99%, respectively, of the total amount of these inhibitors in SF. Most