How Has Molecular Biology Enhanced Our Undertaking of axSpA and Its Management.
Axial spondyloarthritis
Bone metabolism
Genetic
Immune response
Spondyloarthritis
Treatment target
Journal
Current rheumatology reports
ISSN: 1534-6307
Titre abrégé: Curr Rheumatol Rep
Pays: United States
ID NLM: 100888970
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
accepted:
23
05
2022
pubmed:
30
10
2022
medline:
11
1
2023
entrez:
29
10
2022
Statut:
ppublish
Résumé
This review aims at investigating pathophysiological mechanisms in spondyloarthritis (SpA). Analysis of genetic factors, immunological pathways, and abnormalities of bone metabolism lay the foundations for a better understanding of development of the axial clinical manifestations in patients, allowing physician to choose the most appropriate therapeutic strategy in a more targeted manner. In addition to the contribution of MHC system, findings emerged about the role of non-HLA genes (as ERAP1 and 2, whose inhibition could represent a new therapeutic approach) and of epigenetic mechanisms that regulate the expression of genes involved in SpA pathogenesis. Increasing evidence of bone metabolism abnormalities secondary to the activation of immunological pathways suggests the development of various bone anomalies that are present in axSpA patients. SpA are a group of inflammatory diseases with a multifactorial origin, whose pathogenesis is linked to the genetic predisposition, the action of environmental risk factors, and the activation of immune response. It is now well known how bone metabolism leads to long-term structural damage via increased bone turnover, bone loss and osteoporosis, osteitis, erosions, osteosclerosis, and osteoproliferation. These effects can exist in the same patient over time or even simultaneously. Evidence suggests a cross relationship among innate immunity, autoimmunity, and bone remodeling in SpA, making treatment approach a challenge for rheumatologists. Specifically, treatment targets are consistently increasing as new drugs are upcoming. Both biological and targeted synthetic drugs are promising in terms of their efficacy and safety profile in patients affected by SpA.
Identifiants
pubmed: 36308677
doi: 10.1007/s11926-022-01092-4
pii: 10.1007/s11926-022-01092-4
pmc: PMC9825525
doi:
Substances chimiques
ERAP1 protein, human
EC 3.4.11.-
Aminopeptidases
EC 3.4.11.-
Minor Histocompatibility Antigens
0
Types de publication
Journal Article
Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
12-33Informations de copyright
© 2022. The Author(s).
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