# A Lymphatic Perspective on Obesity and Inflammatory Arthritis: New Disease-Modifying Potential in Rheumatology

## TL;DR

Obesity worsens inflammatory arthritis by disrupting lymphatic function, leading to chronic inflammation and poor treatment outcomes.

## Contribution

This review introduces a new perspective on how obesity, lymphatic dysfunction, and inflammation interact in arthritis, suggesting novel therapeutic approaches.

## Key findings

- Obesity impairs lymphatic function through adipose tissue compression and inflammation.
- Lymphatic dysfunction contributes to chronic inflammation in inflammatory arthritis.
- Targeting lymphatic function may offer new therapeutic strategies for arthritis treatment.

## Abstract

Recent studies show that obesity significantly increases disease severity and progression in several forms of inflammatory arthritis, including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and gout. Obesity increases the risk for developing inflammatory arthritis. Similarly, obesity negatively impacts disease severity and treatment outcomes. The underlying mechanisms driving these relationships are not fully understood. One emerging area of investigation is the role of the lymphatic vasculature. Obesity profoundly impacts lymphatic function. Excess adipose tissue can compress and disrupt lymphatic vessels, leading to impaired flow and drainage. Additionally, obesity-associated inflammation and metabolic dysregulation have been linked to lymphatic endothelial cell dysfunction, further compromising transport and immunoregulatory capacities. This impairment fosters an environment for the accumulation of inflammatory cells and mediators, sustaining chronic inflammation. In this review, we will provide new perspectives on the detrimental triangle of obesity, lymphatic dysfunction, and inflammation in chronic inflammatory arthritis and find new starting points for therapeutics.