Secondary lymphoid organs such as lymph nodes (LNs) are the home of peripheral tolerance mechanisms which control autoreactive T cells and prevent immune responses to self-antigen. In systemic autoimmunity, there is a clear failure of these peripheral tolerance mechanisms that leads to chronic inflammation and tissue destruction, highlighting the role for LNs as possible gatekeepers of autoimmunity. In recent years there has been a shift in research focus towards tissue sites in autoimmune diseases ranging from type 1 diabetes to rheumatoid arthritis in an effort to better characterise pathogenesis and guide diagnostic and therapeutic decisions. Although this has yielded great insight, it fails to tackle the initial break in tolerance that initiates disease progression which is most likely originating in peripheral LNs. In the majority of autoimmune diseases a preclinical phase is recognised. This is characterised by the presence of autoantibodies, which is indicative of a break in immune tolerance, and the absence of clinically apparent inflammation or tissue destruction. This review explores how our current knowledge of LNs in the preclinical and established phases of autoimmune diseases provides insight into possibly shared pathological mechanisms that drive disease progression and highlight the gaps in our knowledge that may help uncover new therapeutic avenues for intervention and prevention.

Aoife M O'Byrne

Lisa G M van Baarsen

RMD Open

RMD Open publishes high quality peer-reviewed original research covering the full spectrum of musculoskeletal disorders, rheumatism and connective tissue diseases, including osteoporosis, spine and rehabilitation. Clinical and epidemiological research, basic and translational medicine, interesting clinical cases, and smaller studies that add to the literature are all considered.

RMD Open publishes high-quality peer-reviewed original research covering the full spectrum of musculoskeletal disorders, rheumatism, and connective tissue diseases, including osteoporosis, spine issues, and rehabilitation. The journal considers clinical and epidemiological research, basic and translational medicine, interesting clinical cases, and smaller studies that contribute to the literature.

RMD Open 期刊发表高质量的同行评审原创研究，涵盖肌肉骨骼疾病、风湿病和结缔组织疾病的各个方面，包括骨质疏松、脊柱及康复。我们接受临床和流行病学研究、基础和转化医学、引人注目的临床案例，以及能够丰富文献的小型研究。

Category	Quartile
医学	2
医学, 风湿病学	2

Lymph nodes as gatekeepers of autoimmune diseases

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