Ankylosing Spondylitis Pathogenesis and Pathophysiology

Abstract

The pathogenesis and pathophysiology of Ankylosing Spondylitis (AS) is complex and remains only partially understood. Contributory genes including a variety of HLA-B27 subset genes and many other non-HLA genes are implicated in the literature. Novel genes and gene–gene interactions being a continuously evolving area of AS research. Dysregulation of the enteric microbiome with a corresponding aberrant immunological response is recognised in research. Certain infectious agents are thought to play a role. A variety of other influences including environmental exposures, dietary and lifestyle factors and sex hormones appear to play a role in AS pathogenesis. There is emerging evidence that that pathophysiological response in AS is an elaborate combination of both autoinflammatory and autoimmune components, however the IL-17/IL-23 pathway remains the major pathway in AS according to studies to date. The specific mechanisms that lead to characteristic clinical features of AS including sacroiliitis, spondylitis, ankylosis, uveitis and other extra articular manifestations remain occult. Further research to establish these is ongoing.

Collagen in Orthopedics: From Molecules to Therapies

“…ultimately, a progressive increase in spinal rigidity resulting in loss of flexibility and movement due to complete fusion of the spine [32]. While the pathophysiology of AS is yet to be elucidated, it is associated with the HLA B27 gene polymorphism [33].…”

The Efficacy and Safety of Biologics in Treating Ankylosing Spondylitis and Their Impact on Quality of Life and Comorbidities: A Literature Review

“…However, certain factors have been identified to play an essential role in its pathogenesis, including genetics, certain infections, environmental exposure, and sex hormones. Based on emerging evidence, the pathophysiological response in AS has been identified as a combination of auto-inflammatory and autoimmune processes [ 8 ]. AS has a vital genetic component with high monozygotic twin concordance and a high heritability rate of 63% and 90%, respectively [ 9 , 10 ].…”

Efficacy and safety of biologics in treating ankylosing spondylitis and their impact on quality of life and comorbidities: a narrative review

“…However, certain factors have been identified to play an essential part in the process, including genetics, certain infections, environmental exposure, and sex hormones appear to play a role in the pathogenesis. Based on emerging evidence, the pathophysiological response in AS has been identified as a combination of auto-inflammatory and autoimmune processes [8]. AS has a vital genetic component with high monozygotic twin concordance and a high heritability rate of 63% and 90%, respectively [9,10].…”