Braun J
Rheumatologisches Versorgungszentrum Steglitz, Ruhr Universität Bochum, Schloßstr.110, 12163, Berlin, Germany.
Curr Rheumatol Rep. 2025 Jan 27;27(1):15. doi: 10.1007/s11926-024-01179-0.
Axial spondyloarthritis (axSpA) is a rather prevalent chronic inflammatory rheumatic disease that affects already relatively young patients. It has been known better since the end of the nineteenth century but quite a lot has been learned since the early 60ies when the first classification (diagnostic) criteria for ankylosing spondylitis (AS) were agreed on. I have been part of many developments in the last 30 years, and I'm happy to have been able to contribute to the scientific progress in terms of diagnosis, imaging, pathophysiology and therapy. When I was asked to write a manuscript about the SpA concept I felt honored. Thus, the purpose of this extensive review was, on the one hand, to describe the history of AS and axSpA, and on the other hand, to reason about the concept and the gestalt of axSpA, and finally to deliver some ideas what future researchers could possibly do to further study the disease.
The last 3 decades were full of innovations for both, classification and treatment of axSpA which also helped us to learn about the pathophysiology. Thus, TNFa, IL-17, IL-23 and Janus kinase are established targets to reduce inflammation. IL-17 and IL-23 are very special in that regard because they both work for psoriasis but only anti-IL-17 agents which don't work in IBD are approved for axSpA, while IL 23 inhibitors are approved for both, psoriasis and IBD, but they don't work in axSpA. New imaging techniques such as low dose CT and synthetic MRI are likely to improve the detection of both active and structural lesions of axSpA. This manuscript tries to describe the most important findings about axSpA. The main aim of research remains to discover the pathophysiology and to further improve treatment options in order to reduce and abolish inflammation and prevent new bone formation to increase the quality of life of our patients. The differences between male and female disease and the role of the immune system in axSpA are now the main challenges, and the role of special T-cell receptors seem to deserve special interest.
中轴型脊柱关节炎（axSpA）是一种相当常见的慢性炎症性风湿性疾病，影响的患者相对年轻。自19世纪末以来人们对其已有一定了解，但自60年代初强直性脊柱炎（AS）的首个分类（诊断）标准达成共识后，又有了很多新认识。在过去30年里我参与了诸多进展，很高兴能在诊断、影像学、病理生理学及治疗方面为科学进步做出贡献。当受邀撰写一篇关于脊柱关节炎概念的文稿时，我深感荣幸。因此，这篇全面综述的目的，一方面是描述AS和axSpA的历史，另一方面是探讨axSpA的概念和整体特征，最后提出一些想法，供未来的研究人员进一步研究该疾病时参考。
过去30年里，axSpA的分类和治疗都有诸多创新，这也有助于我们了解其病理生理学。因此，肿瘤坏死因子α（TNFα）、白细胞介素-17（IL-17）、白细胞介素-23（IL-23）和Janus激酶已成为减轻炎症的既定靶点。IL-17和IL-23在这方面非常特殊，因为它们对银屑病都有作用，但仅抗IL-17药物（对炎症性肠病无效）被批准用于axSpA，而IL-23抑制剂对银屑病和炎症性肠病均获批准，但对axSpA无效。新的成像技术，如低剂量CT和合成磁共振成像，可能会提高axSpA活动期和结构损伤的检测能力。本文试图描述关于axSpA的最重要发现。研究的主要目标仍是发现其病理生理学并进一步改善治疗方案，以减轻和消除炎症，防止新骨形成，从而提高患者的生活质量。男性和女性疾病的差异以及免疫系统在axSpA中的作用，现在是主要挑战，特殊T细胞受体的作用似乎值得特别关注。
