4.7 Review

Uncovering the Underworld of Axial Spondyloarthritis

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Article Rheumatology

ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update

Sofia Ramiro et al.

Summary: The ASAS-EULAR recommendations provide updated guidance on the management of axial spondyloarthritis, including treatment targets, non-pharmacological interventions, and the use of non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line pharmacological treatment. For patients with comorbidities, the use of biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) is recommended. The recommendations also cover the management of extramusculoskeletal manifestations, tapering of bDMARDs, and surgical interventions.

ANNALS OF THE RHEUMATIC DISEASES (2023)

Article Rheumatology

Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 1 trial

Lars Erik Kristensen et al.

Summary: Risankizumab treatment significantly improves signs and symptoms of PsA compared to placebo, demonstrating significant differences in skin and nail psoriasis endpoints, minimal disease activity, and resolution of enthesitis and dactylitis. Adverse events were reported at similar rates in the risankizumab and placebo groups.

ANNALS OF THE RHEUMATIC DISEASES (2022)

Article Rheumatology

Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 2 trial

Andrew Ostor et al.

Summary: The study found that treatment with risankizumab resulted in significant improvements in key disease outcomes for patients with PsA who were Bio-IR and/or csDMARD-IR, and was well tolerated.

ANNALS OF THE RHEUMATIC DISEASES (2022)

Article Cell Biology

Upregulation of Unfolded Protein Response and ER Stress-Related IL-23 Production in M1 Macrophages from Ankylosing Spondylitis Patients

Alireza Rezaiemanesh et al.

Summary: ER stress in macrophages from AS patients plays a role in the increased production of IL-23. The autophagy pathway is not involved in the modulation of IL-23 production by AS macrophages.

INFLAMMATION (2022)

Review Rheumatology

Janus kinase-targeting therapies in rheumatology: a mechanisms-based approach

Yoshiya Tanaka et al.

Summary: This Review discusses the therapeutic use of Janus kinase inhibitors in autoimmune rheumatic diseases, highlighting their disease-specific mechanisms of action. JAK inhibitors suppress intracellular signaling mediated by multiple cytokines, offering potential treatment options for a range of immune and inflammatory disorders.

NATURE REVIEWS RHEUMATOLOGY (2022)

Review Rheumatology

A review of JAK-STAT signalling in the pathogenesis of spondyloarthritis and the role of JAK inhibition

Iain B. McInnes et al.

Summary: Spondyloarthritis (SpA) is a group of chronic inflammatory diseases characterized by overlapping clinical, genetic and pathophysiological features. Various cytokines are involved in the pathogenesis of SpA, and inhibition of the JAK signaling pathway can suppress SpA development. This article discusses the role of JAK signaling in the pathogenesis of SpA and summarizes the safety and efficacy of JAK inhibition based on relevant clinical trials.

RHEUMATOLOGY (2022)

Article Rheumatology

Central sensitization has major impact on quality of life in patients with axial spondyloarthritis

Stan C. Kieskamp et al.

Summary: This study examined the relationship between central sensitization (CS) and quality of life in patients with axial spondyloarthritis (axSpA). The findings suggest that CS is strongly associated with patient-reported quality of life, independently from other patient- and disease-related aspects.

SEMINARS IN ARTHRITIS AND RHEUMATISM (2022)

Review Rheumatology

Gut microbiota changes in patients with spondyloarthritis: A systematic review

Lei Wang et al.

Summary: This study conducted a systematic review on the characteristics of gut microbiota in patients with Spondyloarthritis (SpA) compared to healthy controls, and found significant differences. Specific taxa-level differences were identified in different subtypes of SpA. The findings lay the groundwork for evidence-based microbial treatment.

SEMINARS IN ARTHRITIS AND RHEUMATISM (2022)

Article Rheumatology

Characterization of Blood Mucosal-Associated Invariant T Cells in Patients With Axial Spondyloarthritis and of Resident Mucosal-Associated Invariant T Cells From the Axial Entheses of Non-Axial Spondyloarthritis Control Patients

Nicolas Rosine et al.

Summary: This study aims to characterize the major IL-17A-producing blood cell populations in patients with axial SpA, with a focus on MAIT cells. The results showed that MAIT cells produced the most IL-17A in peripheral blood compared to other cell populations, and IL-17A was also produced by MAIT cells in normal axial entheses. This suggests that both peripheral blood MAIT cells and resident MAIT cells in normal entheses may play important roles in the pathogenesis of axial SpA.

ARTHRITIS & RHEUMATOLOGY (2022)

Review Immunology

Innate Lymphoid Cells in Autoimmune Diseases

Aurelie S. Clottu et al.

Summary: Innate lymphoid cells (ILC) are a group of immune cells similar to T cells in morphology and cytokine profile, but they lack clonally distributed diverse antigen receptors. ILC, especially ILC1, ILC2, and ILC3, express transcription factors and cytokines similar to T helper cells, and play an important role in innate immunity by responding rapidly to pathogens. Recent studies have shown that alterations in the number and function of ILC are associated with autoimmune diseases such as systemic lupus erythematosus, systemic sclerosis, and rheumatoid arthritis.

FRONTIERS IN IMMUNOLOGY (2022)

Article Immunology

Differences in Cellular Clearing Mechanisms of Aggregates of Two Subtypes of HLA-B27

Amit Kumar Thakur et al.

Summary: Ankylosing spondylitis (AS) is a type of spondyloarthropathy strongly associated with the genetic marker HLA-B27. This study investigates the differential disease association of two HLA-B27 subtypes, B*2704 and B*2709, and finds distinct protein clearance mechanisms involved in their degradation. These findings provide insights into the different pathogenic outcomes of these HLA-B27 subtypes.

FRONTIERS IN IMMUNOLOGY (2022)

Review Rheumatology

Treatment of axial spondyloarthritis: an update

Abhijeet Danve et al.

Summary: This review summarizes the progress in the pharmacological management of axial spondyloarthritis (axSpA), including newly approved biologic DMARDs. With advances in the understanding of the immunopathogenesis of this disease, new therapies have become available, which can substantially improve symptoms, signs and quality of life.

NATURE REVIEWS RHEUMATOLOGY (2022)

Article Immunology

Increased proportions of inflammatory T cells and their correlations with cytokines and clinical parameters in patients with ankylosing spondylitis from northern Sweden

Kristina Lejon et al.

Summary: This study analyzed the levels of inflammatory T cell subsets in AS patients from northern Sweden and found increased proportions of Th17, Th22, and Tc22 cells in male AS patients. There were correlations between plasma cytokine levels and T cell proportions in male patients, and a negative correlation between Tc22 cells and C-reactive protein in female patients. These findings suggest the involvement of different T cell subsets in the pathogenesis of AS.

SCANDINAVIAN JOURNAL OF IMMUNOLOGY (2022)

Article Multidisciplinary Sciences

Trained ILC3 responses promote intestinal defense

Nicolas Serafini et al.

Summary: Group 3 innate lymphoid cells (ILC3s) in the intestine remain activated for months after exposure to Citrobacter rodentium, leading to enhanced immune response and defense capability. These trained ILC3s undergo metabolic changes and exhibit enhanced proliferative capacity and IL-22 production.

SCIENCE (2022)

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Upregulated of ANXA3, SORL1, and Neutrophils May Be Key Factors in the Progressionof Ankylosing Spondylitis

Jie Jiang et al.

Summary: ANXA3, SORL1, and neutrophils upregulation may play a key role in the progression of Ankylosing spondylitis.

FRONTIERS IN IMMUNOLOGY (2022)

Article Cell Biology

Transfer of microRNA-22-3p by M2 macrophage-derived extracellular vesicles facilitates the development of ankylosing spondylitis through the PER2-mediated Wnt/β-catenin axis

Chong Liu et al.

Summary: This study aimed to elucidate the mechanism of miR-22-3p from M2 macrophage-derived EVs in promoting the osteogenic differentiation of MSCs in AS, and found that miR-22-3p downregulates PER2 to facilitate MSCs osteogenesis via the Wnt/beta-catenin axis.

CELL DEATH DISCOVERY (2022)

Review Medicine, Research & Experimental

Levels of Peripheral Th17 Cells and Th17-Related Cytokines in Patients with Ankylosing Spondylitis: A Meta-analysis

Qin-Yi Su et al.

Summary: This meta-analysis examined the levels of Th17 cells and serum Th17-associated cytokines in patients with ankylosing spondylitis (AS). The results showed that AS patients had higher levels of Th17 cells and cytokines such as IL-17, IL-21, and IL-23 compared to healthy controls. Additionally, these levels were significantly higher in active AS compared to stable AS.

ADVANCES IN THERAPY (2022)

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DKK-1 Is Underexpressed in Mesenchymal Stem Cells from Patients with Ankylosing Spondylitis and Further Downregulated by IL-17

Dimitrios Daoussis et al.

Summary: This study investigated the expression of DKK-1 gene and activation of the Wnt pathway in MSCs from patients with ankylosing spondylitis (AS) and the effect of IL-17 on MSCs. The results showed that DKK-1 was downregulated in MSCs and osteoblasts from AS patients compared to controls, while Wnt pathway activation and osteoblastic activity were increased. IL-17 suppressed DKK-1 expression and promoted osteoblastic function. These findings have important implications in the pathogenesis and clinical aspects of AS.

INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES (2022)

Article Immunology

TCR repertoire profiling revealed antigen-driven CD8+T cell clonal groups shared in synovial fluid of patients with spondyloarthritis

Ekaterina A. Komech et al.

Summary: This study identified expanded T cell clones in synovial fluid of spondyloarthritis (SpA) patients, which were shared between patients with similar HLA genotypes and persisted during recurrent synovitis. Several antigen-driven CD8+ clone groups associated with specific HLA alleles were discovered, indicating their relevance to SpA pathogenesis. These findings suggest a common immunopathological mechanism and the role of specific CD8+ T cell clones in SpA.

FRONTIERS IN IMMUNOLOGY (2022)

Article Medicine, General & Internal

HLA-B*27 Heavy Chain Homo-Oligomers Promote the Cytotoxicity of NK Cells via Activation of PI3K/AKT Signaling

Hui-Chun Yu et al.

Summary: Stimulation of NK cell-mediated cytotoxicity by homo-oligomeric B*27-HC molecules may be involved in the pathogenesis of AS.

MEDICINA-LITHUANIA (2022)

Article Rheumatology

Serum granulocyte-macrophage colony-stimulating factor (GM-CSF) is increased in patients with active radiographic axial spondyloarthritis and persists despite anti-TNF treatment

Charalampos Papagoras et al.

Summary: This study found that GM-CSF levels are increased in patients with active ankylosing spondylitis (AS) and strongly correlate with disease activity. Anti-TNF treatment improves disease activity but does not affect GM-CSF levels. This suggests that GM-CSF may represent an important pathway responsible for residual inflammation during TNF blockade and a potential target of JAK inhibitors in radiographic AS.

ARTHRITIS RESEARCH & THERAPY (2022)

Article Cell Biology

RANKL expression of primary osteoblasts is enhanced by an IL-17-mediated JAK2/STAT3 pathway through autophagy suppression

Zhongxiu Wang et al.

Summary: The study demonstrated that IL-17 modulates RANKL expression in osteoblasts through the autophagy-JAK2-STAT3 signaling pathway, ultimately affecting bone metabolism.

CONNECTIVE TISSUE RESEARCH (2021)

Article Rheumatology

Neuropathic component of low back pain in patients with ankylosing spondylitis

Pinar Borman et al.

Summary: Neuropathic back pain is common in patients with ankylosing spondylitis (AS), with over half of patients experiencing this type of pain. It is associated with the functional status and quality of life of individuals with AS.

MODERN RHEUMATOLOGY (2021)

Article Immunology

IL-17A expressed on neutrophil extracellular traps promotes mesenchymal stem cell differentiation toward bone-forming cells in ankylosing spondylitis

Charalampos Papagoras et al.

Summary: The research found that neutrophil extracellular traps (NETs) formation was enhanced in patients with ankylosing spondylitis. NETs decorated with interleukin-17A (IL-17A) stimulated the differentiation of bone marrow mesenchymal stem cells (MSCs) towards bone-forming cells. The expression of IL-17A was regulated by IL-1 beta, and blocking the IL-1 beta signaling pathway disrupted osteogenesis driven by IL-17A-bearing NETs.

EUROPEAN JOURNAL OF IMMUNOLOGY (2021)

Article Rheumatology

Neutrophil extracellular traps and inflammatory response: Implications for the immunopathogenesis of ankylosing spondylitis

Jose Francisco Zambrano-Zaragoza et al.

Summary: This study demonstrated that immune complexes formed with p30 of Salmonella typhimurium and anti-p30 antibodies in AS patients' sera can induce the release of NETs and pro-inflammatory cytokines in neutrophils, shedding light on the role of innate immunity in the inflammatory response of AS.

INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES (2021)

Review Endocrinology & Metabolism

Sclerostin: from bench to bedside

Sakae Tanaka et al.

Summary: Sclerostin negatively regulates canonical Wnt signaling pathways by binding to LRP5/6, while Romosozumab, a specific anti-sclerostin antibody, indirectly activates this pathway to promote bone formation.

JOURNAL OF BONE AND MINERAL METABOLISM (2021)

Review Immunology

The immunology of rheumatoid arthritis

Cornelia M. Weyand et al.

Summary: The progressive loss of immune cell tolerance underlies the immunopathology associated with rheumatoid arthritis, which spans decades and involves the production of autoantibodies and dysfunctional immune system remodeling. The erosion of tissue tolerance leads to joint inflammation, as tissue-invasive effector T cells emerge and protective joint-resident macrophages fail. The loss of T cell tolerance is caused by defective DNA repair, abnormal cell cycle dynamics, and mitochondrial and lysosomal anomalies, leading to the generation of short-lived tissue-invasive effector T cells.

NATURE IMMUNOLOGY (2021)

Review Rheumatology

Axial spondyloarthritis: concept, construct, classification and implications for therapy

Philip C. Robinson et al.

Summary: The concept of axial spondyloarthritis (axSpA) has evolved significantly since the definition of ankylosing spondylitis in 1984, from solely erosions in the sacroiliac joints to a spectrum of disease with or without visible changes on plain radiographs. The use of MRI has greatly impacted the diagnosis and classification of axSpA, yet there is still controversy surrounding the specificity of current classification criteria.

NATURE REVIEWS RHEUMATOLOGY (2021)

Review Immunology

The enigmatic role of HLA-B*27 in spondyloarthritis pathogenesis

Fatemeh Navid et al.

Summary: Establishing a clear role for HLA-B*27 in the pathogenesis of spondyloarthritis remains challenging, with recent studies suggesting potential links to abnormal bone formation and increased osteoblast mineralization. Further research is needed to fully understand the mechanisms behind these associations.

SEMINARS IN IMMUNOPATHOLOGY (2021)

Review Biochemistry & Molecular Biology

B Cell Involvement in the Pathogenesis of Ankylosing Spondylitis

Rick Wilbrink et al.

Summary: Research suggests that genetics, immune reactions, and the joint-gut axis play major roles in the etiology of ankylosing spondylitis (AS). While B cells have been traditionally understudied in AS pathogenesis, increasing evidence points to their involvement, with disturbances in B cell populations and the formation of antibodies seen in AS patients.

INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES (2021)

Review Immunology

Innate Cells: The Alternative Source of IL-17 in Axial and Peripheral Spondyloarthritis?

Nicolas Rosine et al.

Summary: Spondyloarthritis is a chronic inflammatory rheumatism with various forms, potentially associated with extra-articular manifestations. Studies have shown similarities in the pathophysiology of the disease, particularly in the IL-23/IL-17 pathway, but there are significant differences in the efficacy of IL-23-targeted treatments between different disease types.

FRONTIERS IN IMMUNOLOGY (2021)

Review Biochemistry & Molecular Biology

The Role of Tumor Necrosis Factor Alpha (TNF-α) in Autoimmune Disease and Current TNF-α Inhibitors in Therapeutics

Dan-in Jang et al.

Summary: TNF-α was originally identified as a factor causing tumor necrosis but has also been recognized as a pathological component of autoimmune diseases. Its signaling pathways play important roles in cellular responses, and inappropriate activation can lead to chronic inflammation and autoimmune diseases. TNF-α inhibitors have been developed as effective therapeutic tools for various autoimmune diseases.

INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES (2021)

Article Rheumatology

Tumor Necrosis Factor Inhibitors Reduce Spinal Radiographic Progression in Patients With Radiographic Axial Spondyloarthritis: A Longitudinal Analysis from the Alberta Prospective Cohort

Alexandre Sepriano et al.

Summary: The study found that TNFi can slow down spinal radiographic progression in patients with radiographic axial SpA, which may be partially related to their effects on inflammation as measured by the ASDAS.

ARTHRITIS & RHEUMATOLOGY (2021)

Review Immunology

Role of the IL-23/IL-17 Pathway in Rheumatic Diseases: An Overview

Claudia Schinocca et al.

Summary: IL-23 is a pro-inflammatory cytokine composed of two subunits and has a key role in protective immune response, but dysregulation can exacerbate chronic immune-mediated inflammation. Activation of the IL-23/IL-17 axis contributes to the development of various inflammatory diseases.

FRONTIERS IN IMMUNOLOGY (2021)

Article Rheumatology

Tofacitinib for the treatment of ankylosing spondylitis: a phase III, randomised, double-blind, placebo-controlled study

Atul Deodhar et al.

Summary: Tofacitinib demonstrated significantly greater efficacy compared to placebo in treating active ankylosing spondylitis in adults, with good safety profile and no new safety risks identified.

ANNALS OF THE RHEUMATIC DISEASES (2021)

Article Multidisciplinary Sciences

Monocyte-derived and M1 macrophages from ankylosing spondylitis patients released higher TNF-α and expressed more IL1B in response to BzATP than macrophages from healthy subjects

Maryam Akhtari et al.

Summary: Macrophages play a role in the pathogenesis of ankylosing spondylitis by producing inflammatory cytokines in response to extracellular adenosine triphosphate (eATP). A study investigated the effect of BzATP on monocyte-generated and M1 macrophages from AS patients and controls, finding that AS macrophages were more sensitive and responded more intensively to BzATP. The diverse effects of BzATP on different types of macrophages suggest varied inflammatory properties in response to eATP.

SCIENTIFIC REPORTS (2021)

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Paradoxical Augmentation of Experimental Spondyloarthritis by RORC Inhibition in HLA-B27 Transgenic Rats

Melissa N. van Tok et al.

Summary: Although RORC inhibitor treatment significantly suppresses the IL-17 axis, it accelerates and aggravates experimental SpA in the HLA-B27 tg rat model.

FRONTIERS IN IMMUNOLOGY (2021)

Review Immunology

Imbalance of Peripheral Lymphocyte Subsets in Patients With Ankylosing Spondylitis: A Meta-Analysis

Dong Liu et al.

Summary: Ankylosing spondylitis is a complex autoimmune disease involving genetic and environmental factors. B cells were found to be significantly increased in AS patients, while Tregs were decreased and Th17 cells were increased. The imbalance between Th17 and Tregs, as well as between Th1 and Th2, may play a role in the pathogenesis of ankylosing spondylitis. Further research is needed to clarify the interactions between different lymphocyte subsets in AS patients.

FRONTIERS IN IMMUNOLOGY (2021)

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Assessment of Neuropathic Pain in Ankylosing Spondylitis: Prevalence and Characteristics

Ling Zhou et al.

Summary: This study found a high prevalence of neuropathic pain in ankylosing spondylitis patients, which may be more significant than inflammatory pain. Neuropathic pain contributes significantly to pain in AS patients and has an impact on disease activity and psychological status.

PAIN AND THERAPY (2021)

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Sustained clinical response and safety of etanercept in patients with early axial spondyloarthritis: 10-year results of the ESTHER trial

Fabian Proft et al.

Summary: The study aimed to assess the long-term clinical efficacy of etanercept in early axSpA patients who participated in the 10-year extension of the ESTHER-trial. In those who completed the study, a sustained clinical response was observed over the 10-year period with no significant differences between radiographic and non-radiographic axSpA subgroups. Etanercept was well tolerated and showed a good safety profile with no new safety signals.

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Neuropathic pain in ankylosing spondylitis: a meta-analysis

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IL-17 alters the mesenchymal stem cell niche towards osteogenesis in cooperation with osteocytes

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Altered Cytotoxicity Profile of CD8+T Cells in Ankylosing Spondylitis

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Jose A. Lopez de Castro

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IL-17A induces osteoblast differentiation by activating JAK2/STAT3 in ankylosing spondylitis

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