Practical Significance of Biomarkers in Axial Spondyloarthritis: Updates on Diagnosis, Disease Activity, and Prognosis

Abstract

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that can lead to ankylosis by secondary ossification of inflammatory lesions, with progressive disability and a significant impact on quality of life. It is also a risk factor for the occurrence of comorbidities, especially cardiovascular diseases (CVDs), mood disorders, osteoporosis, and malignancies. Early diagnosis and treatment are needed to prevent or decrease functional decline and to improve the patient’s prognosis. In respect of axSpA, there is an unmet need for biomarkers that can help to diagnose the disease, define disease activity and prognosis, and establish personalized treatment approaches. The aim of this review was to summarize the available information regarding the most promising biomarkers for axSpA. We classified and identified six core categories of biomarkers: (i) systemic markers of inflammation; (ii) molecules involved in bone homeostasis; (iii) HLA-B27 and newer genetic biomarkers; (iv) antibody-based biomarkers; (v) microbiome biomarkers; and (vi) miscellaneous biomarkers. Unfortunately, despite efforts to validate new biomarkers, few of them are used in clinical practice; however, we believe that these studies provide useful data that could aid in better disease management.

Comparison of Incidence or Recurrence of Anterior Uveitis in Patients with Ankylosing Spondylitis Treated with Tumor Necrosis Factor Inhibitors

“…Future studies should incorporate robust sample size calculations during the study design phase to enhance the reliability and interpretability of the results. Finally, this study did not investigate other potential factors or important biomarkers, such as the disease activity of AS and treatment adherence, which might have influenced the rates of uveitis recurrence and occurrence [5].…”

“…TNFi block the activity of TNFα, a key inflammatory mediator as a pro-inflammatory cytokine. Several studies have established a significant relationship between TNFα and AS [4][5][6][7][8]. TNFα is known to play a crucial role in the pathogenesis of AS, as it is overproduced in AS predominantly by active macrophages and T-lymphocytes, playing key roles in the inflammation of spine and sacroiliac joints and extra-articular manifestations including uveitis [4,5].…”

“…Several studies have established a significant relationship between TNFα and AS [4][5][6][7][8]. TNFα is known to play a crucial role in the pathogenesis of AS, as it is overproduced in AS predominantly by active macrophages and T-lymphocytes, playing key roles in the inflammation of spine and sacroiliac joints and extra-articular manifestations including uveitis [4,5]. Genetic association studies have evaluated the link between TNFα polymorphisms and susceptibility to AS, indicating a potential genetic influence on the development of the disease [6].…”

Association between 91 inflammatory factors combined with 1400 metabolites and ankylosing spondylitis: a two-sample Mendelian randomization study

“…Abnormal regulation of in ammatory factors affects the regulation of metabolic processes, leading to compromised metabolite secretion and synthesis, which in turn triggers in ammatory responses. These in ammatory reactions mainly affect joints such as the spine and pelvis, leading to in ammatory injuries of the sacroiliac joints, spine, paraspinal soft tissues and peripheral joints [19] .…”

Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle?

“…The onset and progression of the axial spondyloarthritis spectrum of diseases clearly has a genetic basis ( Brown et al, 2020 ), with association with HLA B27 ( Masi, 1992 ; Diaconu et al, 2022 ). Recent attempts to identify biomarkers of disease subtypes has progressed ( Akhtari et al, 2020 ; Alber et al, 2022 ), as well as insights into inflammatory mechanisms ( Lee et al, 2022b ).…”