We assessed the contribution of ATP and adenosine (i) to a major sign of acute inflammation, plasma extravasation (PE), in the rat knee joint and (ii) to the severity of joint injury in adjuvant-induced experimental arthritis, a chronic inflammatory disease. PE induced by local infusion of bradykinin, which we have previously shown to depend on the sympathetic postganglionic neuron terminal, was markedly enhanced by coinfusion of either ATP or the adenosine A2-receptor agonist 2-[4-(2-carboxyethyl)phenylethylaminoJ-5'-Nethylcarboxamidoadenosine. Bradykinin-induced PE was inhibited by coinfusion of the ATP receptor antagonist adenosine 5'-[a,4-methyleneltripbosphate, the A2-receptor antagonist 3-(5H-thiozolo[2,3b]quinazolin-3-yl)phenol monohydrochloride, or the adenosine Al-receptor agonist N6-cyclopentyladenosine. The joint injury associated with experimental arthritis, which is reduced in severity in sympathectomized rats, was also markedly attenuated by daily administration of either ATP (40% reduction) or adenosine (55% reduction). These results demonstrate that the purines ATP and adenosine (acting at the A2 receptor), cotransmitters in the sympathetic postganglionic neuron terminal, enhance bradykinin-induced sympathetic postganglionic neuron terminal-dependent PE but inhibit the joint injury of arthritis. These opposing purinergic effects on PE and joint hijury suggest that enhanced PE protects against joint iury.A contribution of the peripheral limb of the sympathetic nervous system to inflammation has been demonstrated in a variety of animal models (1,2) and also in patients with inflammatory diseases, such as rheumatoid arthritis (3, 4). For example, sympathetic nerve stimulation increases vascular permeability, even though it also produces vasoconstriction (5). Consistent with these data, surgical (6, 7) or chemical (8-10) sympathectomy strongly inhibits noxious stimulus-evoked plasma extravasation (PE), a major sign of acute inflammation. Sympathectomy also markedly reduces inflammation and joint injury in rats with adjuvant-induced arthritis (11).We have recently shown that the PE produced by bradykinin (BK), a potent inflammatory agent, is mediated via an action on the sympathetic postganglionic neuron (SPGN) terminal (12). Specifically, sympathectomy significantly reduced PE evoked by infusion of BK into the knee joint of the rat. Although many SPGN neurotransmitters have been identified, our results suggested that release of the known sympathetic "cotransmitters" (i.e., norepinephrine, neuropeptide Y, and ATP) could not alone account for the PE produced by SPGN-terminal stimulation. Thus, norepinephrine inhibited PE, and neuropeptide Y had no effect on PE.Although ATP increased-PE, its effect, even at the highest doses, was smaller in amplitude and much shorter in duration than that produced by BK or by acute activation of SPGN terminals with 6-hydroxydopamine (12). Because indomethacin, a prostaglandin synthesis inhibitor, markedly reduced the PE produced by BK and because SPGNs synthesiz...