超越炎症:轴性脊柱关节炎和银屑病关节炎中骨重塑的分子基础
Beyond inflammation: the molecular basis of bone remodeling in axial spondyloarthritis and psoriatic arthritis.
作者信息
Lopalco Giuseppe, Cito Andrea, Iannone Florenzo, Diekhoff Torsten, Poddubnyy Denis, Proft Fabian
机构信息
Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari, Bari, Italy.
Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.
出版信息
Front Immunol. 2025 Jul 31;16:1599995. doi: 10.3389/fimmu.2025.1599995. eCollection 2025.
Spondyloarthritis (SpA) encompasses a group of chronic inflammatory diseases with overlapping genetic, clinical, and radiographic features. Axial spondyloarthritis (axSpA), a subset of SpA, predominantly involves the sacroiliac joints and spine, often progressing to ankylosis, severe disability, and functional impairment. Psoriatic arthritis (PsA), another SpA subtype, is characterized by a heterogeneous phenotype that includes peripheral arthritis, enthesitis, and axial involvement, frequently associated with psoriasis. Bone remodeling in axSpA and PsA is driven by a dynamic interplay between inflammatory cytokines and the uncoupling of anabolic and catabolic processes, resulting in bone erosion, systemic and local bone loss, and pathological new bone formation. In axSpA, tumor necrosis factor-alpha (TNFα) and interleukin-17A (IL-17A) drive osteoclastogenesis via the RANKL pathway while suppressing osteoblast-mediated bone formation through WNT/β-catenin signaling. Mechanical stress, combined with inflammatory mediators, promotes mesenchymal stem cell differentiation and new bone formation, which manifests as syndesmophytes and contributes to progressive ankylosis. Conversely, PsA is distinguished by concurrent bone erosion and neoformation, driven by IL-17A, IL-22, and IL- 23, with axial disease exhibiting asymmetrical, bulky para-syndesmophytes rather than the fine, hair-like syndesmophytes typical of axSpA. Advanced imaging modalities, particularly MRI, have elucidated key mechanisms of disease progression, revealing processes such as fat metaplasia and reparative changes. This review explores the intricate molecular and cellular mechanisms underlying bone remodeling in SpA, emphasizing both shared pathways and disease-specific features. It aims to enhance the understanding of these processes to support the development of more precise and effective therapeutic approaches tailored to axSpA and PsA.
脊柱关节炎(SpA)是一组具有重叠的遗传、临床和影像学特征的慢性炎症性疾病。轴性脊柱关节炎(axSpA)是SpA的一个亚型,主要累及骶髂关节和脊柱,常进展为关节强直、严重残疾和功能障碍。银屑病关节炎(PsA)是SpA的另一个亚型,其特征是具有异质性表型,包括外周关节炎、附着点炎和轴性受累,常与银屑病相关。axSpA和PsA中的骨重塑是由炎性细胞因子与合成代谢和分解代谢过程的解偶联之间的动态相互作用驱动的,导致骨侵蚀、全身和局部骨质流失以及病理性新骨形成。在axSpA中,肿瘤坏死因子-α(TNFα)和白细胞介素-17A(IL-17A)通过RANKL途径驱动破骨细胞生成,同时通过WNT/β-连环蛋白信号传导抑制成骨细胞介导的骨形成。机械应力与炎性介质相结合,促进间充质干细胞分化和新骨形成,表现为骨桥,导致进行性关节强直。相反,PsA的特点是同时存在骨侵蚀和新骨形成,由IL-17A、IL-22和IL-23驱动,轴性疾病表现为不对称、粗大的副骨桥,而不是axSpA典型的纤细、毛发状骨桥。先进的成像方式,尤其是MRI,已经阐明了疾病进展的关键机制,揭示了诸如脂肪化生和修复性改变等过程。本综述探讨了SpA中骨重塑的复杂分子和细胞机制,强调了共同途径和疾病特异性特征。其目的是加强对这些过程的理解,以支持开发更精确、有效的针对axSpA和PsA的治疗方法。