Introduction:
Lymphatic vessels play a crucial role in clearing fluid and inflammatory cells from inflamed tissues and are also involved in immune tolerance. Given the association of the lymphatics with the immune system, lymphatic dysfunction may contribute to the pathophysiology of rheumatic autoimmune diseases. This review aims to provide an overview of the current understanding of the role of lymphatics in rheumatoid arthritis, scleroderma, lupus, and dermatomyositis, and considers the potential of manual therapies such as massage and acupuncture in improving lymphatic function in autoimmune diseases.
Overview of the Lymphatic System:
- Lymphatic System Overview: The lymphatic system is a network of vessels that drains protein-rich lymph from the extracellular fluid and transports it through a series of lymph nodes, ultimately returning it to the bloodstream. The system is also crucial in immune modulation and induction of tolerance to self-antigens.
- Role Beyond Fluid Transportation: Lymphatic Endothelial Cells (LECs) are involved in various immune cell activities, affecting immune cell function, antigen presentation, and modulation of immune responses. Dysfunction of the lymphatic system can lead to lymphedema, poor immune function, susceptibility to infections, impaired wound healing, and exacerbation of autoimmune diseases.
Lymphatics and Rheumatoid Arthritis:
- Role in RA: Local lymphatics in RA undergo an “expansion phase” to remove excess debris, and when stressed, progress to a “collapsed phase,” leading to damage in the vessels and poor lymphatic clearance. Effective RA treatments, such as TNF inhibition and anti-CD20 therapy, have shown beneficial effects on lymphatic flow.
- Diagnostic and Therapeutic Implications: Promising tools such as indocyanine green near-infrared imaging and power Doppler ultrasound provide sensitive and non-invasive means to monitor lymphatic function and treatment response in RA patients.
Lymphatics and Systemic Sclerosis:
- Lymphatic Dysfunction in Scleroderma: Lymphatic microangiopathy and blockage of lymphatic flow in systemic sclerosis have been demonstrated, emphasizing the potential as a therapeutic target in this disease.
Lymphatics and Systemic Lupus Erythematosus and Dermatomyositis:
- Hints of Dysfunction: Rare but reported occurrences of lymphatic disruption in SLE and dermatomyositis suggest potential lymphatic dysfunction in these conditions.
Potential Approaches to Improving Lymphatic Function:
- Manual Therapies: Techniques like manual lymphatic drainage, dry brushing massage, and peristaltic pulse dynamic compression devices are being explored to improve lymphatic flow, reduce inflammation, and swelling in the affected tissues.
- Acupuncture: Utilizing acupuncture to potentially modulate lymphatic function in autoimmune diseases, based on its ability to stimulate lymphatic vessels and impact immune cell activity.
Conclusions and Future Directions:
- Insights and Future Research: The evidence suggests differential dysfunction of lymphatic flow in rheumatic autoimmune diseases. Further studies focusing on the consequences of dysfunctional flow and alterations in immune cell activity, understanding the causes of lymphatic dysfunction, and exploring ancient therapeutic approaches in the modern context are warranted to expand the therapeutic armamentarium for autoimmune diseases.
This comprehensive review provides a coherent understanding of the role of lymphatics in various rheumatic autoimmune diseases and potential therapeutic approaches to improve lymphatic function in these conditions. The review also sets the stage for future research and therapeutic development in this underexplored area.
