The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

The Concept and Overview of Spondyloarthritis

척추관절염의 개념 및 개관

  • Seo, Mi Ryoung (Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science) ;
  • Baek, Han Joo (Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science)
  • 서미령 (가천대학교 길병원 내과학교실 류마티스내과) ;
  • 백한주 (가천대학교 길병원 내과학교실 류마티스내과)
  • Published : 2013.09.01
⟨ Previous Next ⟩

Abstract

The spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic diseases in association with HLA-B27. They share the clinical features including sacroiliitis, spondylitis, oligoarthritis, enthesitis and extra-articular involvement. Recently ASAS proposed new classification criteria sets of axial and peripheral SpA. They were designed to include non-radiographic SpA, thus can guide the early diagnosis of disease before the structural damage occurs. SpA has a strong genetic predisposition. Non-MHC genes, such as IL23R and ERAP1, as well as HLA-B27 were confirmed as susceptibility genes through several GWAS. Major pathology in SpA is entheseal inflammation and new bone formation. Intrinsic ability of HLA-B27 to trigger innate immune response and several proinflammtory cytokines may contribute to the inflammation in SpA. New bone formation could be explained by a mechanism, partly or completely independent of the inflammatory process.

Keywords

References

  1. Dougados M, Baeten D. Spondyloarthritis. Lancet 2011; 377:2127-2137. https://doi.org/10.1016/S0140-6736(11)60071-8
  2. Rudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009;68:777-783. https://doi.org/10.1136/ard.2009.108233
  3. Rudwaleit M, van der Heijde D, Landewe R, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011;70:25-31. https://doi.org/10.1136/ard.2010.133645
  4. Bywaters EG. Historical aspects of ankylosing spondylitis. Rheumatol Rehabil 1979;18:197-203. https://doi.org/10.1093/rheumatology/18.4.197
  5. Russell AS. Antiquity of spondyloarthropathies. In: Hochberg MC, ed. Rheumatology. 3rd ed. Vol. 2. Philadelphia: Mosby/ Elsevier, 2008:1145-1147.
  6. Moll JM, Haslock I, Macrae IF, Wright V. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome. Medicine (Baltimore) 1974;53:343-364. https://doi.org/10.1097/00005792-197409000-00002
  7. Hammer RE, Maika SD, Richardson JA, Tang JP, Taurog JD. Spontaneous inflammatory disease in transgenic rats expressing HLA-B27 and human beta 2m: an animal model of HLA-B27-associated human disorders. Cell 1990;63: 1099-1112. https://doi.org/10.1016/0092-8674(90)90512-D
  8. Bakland G, Nossent HC. Epidemiology of spondyloarthritis: a review. Curr Rheumatol Rep 2013;15:351. https://doi.org/10.1007/s11926-013-0351-1
  9. Reveille JD, Weisman MH. The epidemiology of back pain, axial spondyloarthritis and HLA-B27 in the United States. Am J Med Sci 2013;345:431-436. https://doi.org/10.1097/MAJ.0b013e318294457f
  10. Calin A, Porta J, Fries JF, Schurman DJ. Clinical history as a screening test for ankylosing spondylitis. JAMA 1977;237: 2613-2614. https://doi.org/10.1001/jama.1977.03270510035017
  11. Sieper J, van der Heijde D, Landewe R, et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis International Society (ASAS). Ann Rheum Dis 2009;68:784-788. https://doi.org/10.1136/ard.2008.101501
  12. Mander M, Simpson JM, McLellan A, Walker D, Goodacre JA, Dick WC. Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis. Ann Rheum Dis 1987;46:197-202. https://doi.org/10.1136/ard.46.3.197
  13. Healy PJ, Helliwell PS. Dactylitis: pathogenesis and clinical considerations. Curr Rheumatol Rep 2006;8:338-341. https://doi.org/10.1007/s11926-006-0062-y
  14. Rosenbaum JT. Characterization of uveitis associated with spondyloarthritis. J Rheumatol 1989;16:792-796.
  15. De Vos M, Cuvelier C, Mielants H, Veys E, Barbier F, Elewaut A. Ileocolonoscopy in seronegative spondylarthropathy. Gastroenterology 1989;96(2 Pt 1):339-344. https://doi.org/10.1016/0016-5085(89)91557-6
  16. Barkham N, Marzo-Ortega H, McGonagle D, Emery P. How to diagnose axial spondyloarthropathy early. Ann Rheum Dis 2004;63:471-472. https://doi.org/10.1136/ard.2003.014589
  17. Sieper J, Rudwaleit M, Khan MA, Braun J. Concepts and epidemiology of spondyloarthritis. Best Pract Res Clin Rheumatol 2006;20:401-417.
  18. Sampaio-Barros PD, Bortoluzzo AB, Conde RA, Costallat LT, Samara AM, Bertolo MB. Undifferentiated spondyloarthritis: a longterm followup. J Rheumatol 2010;37:1195-1199. https://doi.org/10.3899/jrheum.090625
  19. Bennett PH, Burch TA. Population Studies of the Rheumatic Diseases. Amsterdam: Excerpta Medica Foundation, 1968: 456-457.
  20. Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 1984;27:361-368. https://doi.org/10.1002/art.1780270401
  21. Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68(Suppl 2):ii1-44.
  22. Gong Y, Zheng N, Chen SB, et al. Ten years' experience with needle biopsy in the early diagnosis of sacroiliitis. Arthritis Rheum 2012;64:1399-1406. https://doi.org/10.1002/art.33453
  23. Kellgren JH. Diagnostic criteria for population studies. Bull Rheum Dis 1962;13:291-292.
  24. Amor B, Dougados M, Mijiyawa M. Criteria of the classification of spondylarthropathies. Rev Rhum Mal Osteoartic 1990;57:85-89.
  25. Dougados M, van der Linden S, Juhlin R, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 1991;34:1218-1227. https://doi.org/10.1002/art.1780341003
  26. Collantes-Estevez E, Cisnal del Mazo A, Munoz-Gomariz E. Assessment of 2 systems of spondyloarthropathy diagnostic and classification criteria (Amor and ESSG) by a Spanish multicenter study: European Spondyloarthropathy Study Group. J Rheumatol 1995;22:246-251.
  27. Rudwaleit M, Sieper J. Referral strategies for early diagnosis of axial spondyloarthritis. Nat Rev Rheumatol 2012;8:262-268. https://doi.org/10.1038/nrrheum.2012.39
  28. Sieper J, Rudwaleit M. Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann Rheum Dis 2005; 64:659-663. https://doi.org/10.1136/ard.2004.028753
  29. Brown MA, Kennedy LG, MacGregor AJ, et al. Susceptibility to ankylosing spondylitis in twins: the role of genes, HLA, and the environment. Arthritis Rheum 1997;40: 1823-1828. https://doi.org/10.1002/art.1780401015
  30. van der Linden SM, Valkenburg HA, de Jongh BM, Cats A. The risk of developing ankylosing spondylitis in HLA-B27 positive individuals: a comparison of relatives of spondylitis patients with the general population. Arthritis Rheum 1984; 27:241-249. https://doi.org/10.1002/art.1780270301
  31. Reveille JD. Genetics of spondyloarthritis: beyond the MHC. Nat Rev Rheumatol 2012;8:296-304. https://doi.org/10.1038/nrrheum.2012.41
  32. Tam LS, Gu J, Yu D. Pathogenesis of ankylosing spondylitis. Nat Rev Rheumatol 2010;6:399-405. https://doi.org/10.1038/nrrheum.2010.79
  33. Hermann E, Yu DT, Meyer zum Büschenfelde KH, Fleischer B. HLA-B27-restricted CD8 T cells derived from synovial fluids of patients with reactive arthritis and ankylosing spondylitis. Lancet 1993;342:646-650. https://doi.org/10.1016/0140-6736(93)91760-J
  34. May E, Dorris ML, Satumtira N, et al. CD8 alpha beta T cells are not essential to the pathogenesis of arthritis or colitis in HLA-B27 transgenic rats. J Immunol 2003;170: 1099-1105. https://doi.org/10.4049/jimmunol.170.2.1099
  35. Gu J, Rihl M, Marker-Hermann E, et al. Clues to pathogenesis of spondyloarthropathy derived from synovial fluid mononuclear cell gene expression profiles. J Rheumatol 2002;29:2159-2164.
  36. Tran TM, Dorris ML, Satumtira N, et al. Additional human beta2-microglobulin curbs HLA-B27 misfolding and promotes arthritis and spondylitis without colitis in male HLA-B27-transgenic rats. Arthritis Rheum 2006;54:1317- 1327. https://doi.org/10.1002/art.21740
  37. Kollnberger S, Chan A, Sun MY, et al. Interaction of HLA-B27 homodimers with KIR3DL1 and KIR3DL2, unlike HLA-B27 heterotrimers, is independent of the sequence of bound peptide. Eur J Immunol 2007;37:1313- 1322. https://doi.org/10.1002/eji.200635997
  38. Chan AT, Kollnberger SD, Wedderburn LR, Bowness P. Expansion and enhanced survival of natural killer cells expressing the killer immunoglobulin-like receptor KIR3DL2 in spondylarthritis. Arthritis Rheum 2005;52:3586-3595. https://doi.org/10.1002/art.21395
  39. Armaka M, Apostolaki M, Jacques P, Kontoyiannis DL, Elewaut D, Kollias G. Mesenchymal cell targeting by TNF as a common pathogenic principle in chronic inflammatory joint and intestinal diseases. J Exp Med 2008;205:331-337. https://doi.org/10.1084/jem.20070906
  40. Layh-Schmitt G, Colbert RA. The interleukin-23/interleukin- 17 axis in spondyloarthritis. Curr Opin Rheumatol 2008;20:392-397. https://doi.org/10.1097/BOR.0b013e328303204b
  41. DeLay ML, Turner MJ, Klenk EI, Smith JA, Sowders DP, Colbert RA. HLA-B27 misfolding and the unfolded protein response augment interleukin-23 production and are associated with Th17 activation in transgenic rats. Arthritis Rheum 2009;60:2633-2643. https://doi.org/10.1002/art.24763
  42. Bowness P, Ridley A, Shaw J, et al. Th17 cells expressing KIR3DL2+ and responsive to HLA-B27 homodimers are increased in ankylosing spondylitis. J Immunol 2011;186: 2672-2680. https://doi.org/10.4049/jimmunol.1002653
  43. Sherlock JP, Joyce-Shaikh B, Turner SP, et al. IL-23 induces spondyloarthropathy by acting on ROR-${\gamma}t$+ CD3+CD4- CD8-entheseal resident T cells. Nat Med 2012;18:1069-1076. https://doi.org/10.1038/nm.2817
  44. Van der Heijde D, Landewe R, Baraliakos X, et al. Radiographic findings following two years of infliximab therapy in patients with ankylosing spondylitis. Arthritis Rheum 2008;58:3063-3070. https://doi.org/10.1002/art.23901
  45. Vandooren B, Kruithof E, Yu DT, et al. Involvement of matrix metalloproteinases and their inhibitors in peripheral synovitis and down-regulation by tumor necrosis factor alpha blockade in spondylarthropathy. Arthritis Rheum 2004;50: 2942-2953. https://doi.org/10.1002/art.20477
  46. Neidhart M, Baraliakos X, Seemayer C, et al. Expression of cathepsin K and matrix metalloproteinase 1 indicate persistent osteodestructive activity in long-standing ankylosing spondylitis. Ann Rheum Dis 2009;68:1334-1339. https://doi.org/10.1136/ard.2008.092494
  47. Winkler DG, Yu C, Geoghegan JC, et al. Noggin and sclerostin bone morphogenetic protein antagonists form a mutually inhibitory complex. J Biol Chem 2004;279:36293- 36298. https://doi.org/10.1074/jbc.M400521200
  48. Schett G, Zwerina J, David JP. The role of Wnt proteins in arthritis. Nat Clin Pract Rheumatol 2008;4:473-480.
  49. Lories RJ, Derese I, Luyten FP. Modulation of bone morphogenetic protein signaling inhibits the onset and progression of ankylosing enthesitis. J Clin Invest 2005; 115:1571-1579. https://doi.org/10.1172/JCI23738
  50. Appel H, Ruiz-Heiland G, Listing J, et al. Altered skeletal expression of sclerostin and its link to radiographic progression in ankylosing spondylitis. Arthritis Rheum 2009; 60:3257-3262. https://doi.org/10.1002/art.24888
  51. Daoussis D, Liossis SN, Solomou EE, et al. Evidence that Dkk-1 is dysfunctional in ankylosing spondylitis. Arthritis Rheum 2010;62:150-158. https://doi.org/10.1002/art.27231
  52. Sieper J, Appel H, Braun J, Rudwaleit M. Critical appraisal of assessment of structural damage in ankylosing spondylitis: implications for treatment outcomes. Arthritis Rheum 2008;58:649-656. https://doi.org/10.1002/art.23260
  53. Maksymowych WP, Chiowchanwisawakit P, Clare T, Pedersen SJ, ostergaard M, Lambert RG. Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: evidence of a relationship between inflammation and new bone formation. Arthritis Rheum 2009;60:93-102. https://doi.org/10.1002/art.24132
  54. Lories RJ, Luyten FP, de Vlam K. Progress in spondylarthritis: mechanisms of new bone formation in spondyloarthritis. Arthritis Res Ther 2009;11:221. https://doi.org/10.1186/ar2642

Cited by

  1. 강직성 척추염의 침 치료에 대한 최근 연구동향 분석: China National Knowledge Infrastructure 검색을 중심으로 vol.30, pp.4, 2013, https://doi.org/10.18325/jkmr.2020.30.4.79
  2. Biologic therapies for the treatment of ankylosing spondylitis vol.64, pp.2, 2013, https://doi.org/10.5124/jkma.2021.64.2.116