Reveille John D
Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center, 6431 Fannin, MSB 5.270, Houston, TX, 77030, USA.
Clin Rheumatol. 2022 Mar;41(3):617-634. doi: 10.1007/s10067-021-05968-1. Epub 2021 Oct 21.
The spectrum of axial spondyloarthritis (AxSpA) (including both non-radiographic and radiographic AxSpA), also known as ankylosing spondylitis AS, has achieved growing recognition. With the development of treatments not only effective in controlling disease activity but also in slowing radiographic progression, and given the cost and risk profiles of these novel treatments and the limitations of current clinical criteria, imaging and peripheral blood biomarkers (C-reactive protein, HLA-B27 testing), the need for better biomarkers has never been greater. The purpose of this review is to present up-to-date information on the biomarkers for the diagnosis for assessing disease diagnosis, activity, treatment response, and radiographic progression of AxSpA, and entails multiple search strings used to identify articles of interest published in PubMed and the Cochrane database up to May 1, 2021. We present the current status of research in serologic biomarkers such as cytokines, adipokines, matrix metalloproteinases, calprotectin, CD74, antibodies, bone turnover markers, and circulating protein fragments of cartilage and connective tissue degradation and other biomarkers. Despite a great deal of work, most serologic results have been disappointing and to date none perform better than CRP. Recent promising preliminary data for some has been published, but require further confirmation. Transcriptomic biomarkers such as micro-RNAs and genetic biomarkers also show promise to assist in diagnosis and possibly for radiographic severity, including a recently developed panel of genetic risk markers used in a polygenic risk score instrument in AS diagnosis. These need further confirmation and application in AS as well as in nr-AxSpA.
中轴型脊柱关节炎（AxSpA）（包括非放射学和放射学AxSpA），也称为强直性脊柱炎（AS），已得到越来越多的认可。随着不仅能有效控制疾病活动而且能减缓放射学进展的治疗方法的发展，考虑到这些新型治疗方法的成本和风险状况以及当前临床标准、影像学和外周血生物标志物（C反应蛋白、HLA - B27检测）的局限性，对更好的生物标志物的需求从未如此迫切。本综述的目的是提供有关AxSpA疾病诊断、活动度、治疗反应和放射学进展评估的生物标志物的最新信息，并涉及用于识别截至2021年5月1日在PubMed和Cochrane数据库中发表的相关文章的多个检索词。我们介绍了血清学生物标志物如细胞因子、脂肪因子、基质金属蛋白酶、钙卫蛋白、CD74、抗体、骨转换标志物以及软骨和结缔组织降解的循环蛋白片段等其他生物标志物的研究现状。尽管进行了大量工作，但大多数血清学结果都令人失望，迄今为止没有一种比CRP表现更好。最近一些有前景的初步数据已经发表，但需要进一步证实。转录组生物标志物如微小RNA和遗传生物标志物也有望辅助诊断，并可能用于评估放射学严重程度，包括最近开发的一组用于强直性脊柱炎诊断的多基因风险评分工具中的遗传风险标志物。这些需要在强直性脊柱炎以及非放射学中轴型脊柱关节炎中进一步证实和应用。
