Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
Front Immunol. 2021 Jan 7;11:596086. doi: 10.3389/fimmu.2020.596086. eCollection 2020.
Psoriatic arthritis (PsA) is a chronic inflammatory disease belonging to the family of spondyloarthropathies (SpA). PsA commonly aggravates psoriasis of the skin and frequently manifests as an oligoarthritis with axial skeletal involvement and extraarticular manifestations including dactylitis, enthesitis, and uveitis. The weight of genetic predisposition to psoriasis and PsA is illustrated by the concordance rates in monozygotic twins which clearly demonstrate that genomics is insufficient to induce the clinical phenotype. The association of PsA with several single nucleotide polymorphisms (SNPs) at the IL23R locus and the involvement of Th17 cells in the immunopathogenesis of PsA clearly put the IL-23/IL-17 axis in the spotlight. The IL-23 and IL-17 cytokines have a pivotal role in the chronic inflammation of the synovium in PsA and are also prominent in the skin lesions of those with PsA. In this review, we focus on the genetic association of the IL-23/IL-17 axis with PsA and the contribution of these master cytokines in the pathophysiology of the disease, highlighting the main cell types incriminated in PsA and their specific role in the peripheral blood, lesional skin and joints of patients. We then provide an overview of the approved biologic drugs targeting the IL-23/IL-17 axis and discuss the advantages of genetic stratification to enhance personalized therapies in PsA.
银屑病关节炎(PsA)是一种慢性炎症性疾病,属于脊柱关节病(SpA)家族。PsA 常使皮肤银屑病恶化,常表现为寡关节炎,伴有轴向骨骼受累和关节外表现,包括指(趾)炎、附着点炎和葡萄膜炎。银屑病和 PsA 的遗传易感性的重要性可以通过同卵双胞胎的一致性率来证明,这清楚地表明基因组学不足以诱导临床表型。PsA 与 IL23R 基因座的几个单核苷酸多态性(SNPs)相关,以及 Th17 细胞在 PsA 的免疫发病机制中的参与,明确将 IL-23/IL-17 轴置于聚光灯下。IL-23 和 IL-17 细胞因子在 PsA 的滑膜慢性炎症中起着关键作用,在银屑病患者的皮肤损伤中也很突出。在这篇综述中,我们重点关注 IL-23/IL-17 轴与 PsA 的遗传关联以及这些主要细胞因子在疾病发病机制中的作用,强调了在 PsA 中涉及的主要细胞类型及其在患者外周血、皮损皮肤和关节中的特定作用。然后,我们概述了针对 IL-23/IL-17 轴的已批准的生物药物,并讨论了遗传分层以增强 PsA 个性化治疗的优势。
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