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Altered Lymphatic Vessel Anatomy and Markedly Diminished Lymph Clearance in Affected Hands of Patients With Active Rheumatoid Arthritis
Author(s) -
Bell Richard D.,
Rahimi Homaira,
Kenney H. Mark,
Lieberman Alicia A.,
Wood Ronald W.,
Schwarz Edward M.,
Ritchlin Christopher T.
Publication year - 2020
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41311
Subject(s) - medicine , indocyanine green , rheumatoid arthritis , lymphatic system , synovitis , lymph , lymphatic vessel , surgery , nuclear medicine , pathology , metastasis , cancer
Objective To assess differences between lymphatic function in the affected hands of rheumatoid arthritis ( RA ) patients with active synovitis and that of healthy controls, using indocyanine green ( ICG ) dye and near‐infrared ( NIR ) imaging. Methods NIR imaging of the hands of 8 patients with active RA and 13 healthy controls was performed following web space injection of 0.1 ml of 100 μ M ICG . The percentage of ICG retention in the web spaces was determined by NIR imaging at baseline and at 7 days (±1 day) after the initial injections; image analysis provided contraction frequency. ICG + lymphatic vessel ( LV ) length and branching architecture were assessed. Results Retention of ICG in RA hands was higher compared to controls ( P < 0.01). The average contraction frequency of ICG + LV s in RA patients and in controls did not differ (mean ± SD 0.53 ± 0.39 contractions/minute versus 0.51 ± 0.35 contractions/minute). Total ICG + LV length in RA hands was lower compared to healthy controls (58.3 ± 15.0 cm versus 71.4 ± 16.1 cm; P < 0.001), concomitant with a decrease in the number of ICG + basilic LV s in the hands of RA patients ( P < 0.05). Conclusion Lymphatic drainage in the hands of RA patients with active disease was reduced compared to controls. This reduction was associated with a decrease in total length of ICG + LV s on the dorsal surface of the hands, which continued to contract at a similar rate to that observed in controls. These findings provide a plausible mechanism for exacerbation of synovitis and joint damage, specifically the accumulation and retention of inflammatory cells and catabolic factors in RA joints due to impaired efferent lymphatic flow. NIR / ICG imaging of RA hands is feasible and warrants formal investigation as a primary outcome measure for arthritis disease severity and/or persistence in future clinical trials.