title: The role of the lymphatic system in inflammatory-erosive arthritis.
abstract: Rheumatoid arthritis (RA) is a prevalent inflammatory joint disease with enigmatic flares, which causes swelling, pain, and irreversible connective tissue damage. Recently, it has been demonstrated in murine models of RA that the popliteal lymph node (PLN) is a biomarker of arthritic flare, as it "expands" in size and contrast enhancement during a prolonged asymptomatic phase, prior to when it "collapses" with accelerated synovitis and joint erosion. This PLN collapse is associated with adjacent knee flare, decreases in PLN volume and contrast enhancement, lymphatic pulse and pumping pressure, and an increase in PLN pressure. Currently, it is known that PLN collapse is accompanied by a translocation of B cells from the follicles to the sinuses, effectively clogging the lymphatic sinuses of the PLN, and that B cell depletion therapy ameliorates arthritic flare by eliminating these B cells and restoring passive lymphatic flow from inflamed joints. Here we review the technological advances that have launched this area of research, describe future directions to help elucidate the potential mechanism of PLN collapse, and speculate on clinical translation towards new diagnostics and therapies for RA.
authors.affiliation: Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.
authors.forename: Echoe M
authors.initials: EM
authors.lastname: Bouta
authors.affiliation: Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.affiliation: Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.
authors.forename: Yawen
authors.initials: Y
authors.lastname: Ju
authors.affiliation: Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Department of Neurobiology and Anatomy, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.
authors.forename: Edward B
authors.initials: EB
authors.lastname: Brown
authors.affiliation: Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Division of Allergy, Immunology, Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Ritchlin
authors.affiliation: Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.
authors.forename: Lianping
authors.initials: L
authors.lastname: Xing
authors.affiliation: Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Division of Allergy, Immunology, Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States. Electronic address: Edward_Schwarz@URMC.Rochester.edu.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Schwarz
mesh_terms: D000818:Animals; D001172:Arthritis, Rheumatoid / Q000276:immunology / Q000473:pathology*; D001402:B-Lymphocytes / Q000276:immunology; D006801:Humans; D008198:Lymph Nodes / Q000276:immunology / Q000473:pathology*; D008208:Lymphatic System / Q000276:immunology / Q000502:physiology*; D000067251:Symptom Flare Up
keywords: Flare; Lymph node; Lymphatic vessel; Rheumatoid arthritis