Abstract
Spondyloarthritis (SpA) is an umbrella term describing a family of chronic inflammatory rheumatic diseases. These diseases are characterised by inflammation of the axial skeleton, peripheral joints, and entheseal insertion sites throughout the body which can lead to structural joint damage including formation of axial syndesmophytes and peripheral osteophytes. Genetic evidence, preclinical and clinical studies indicate a clear role of interleukin (IL)- 23 and IL-17 as mediators in SpA pathogenesis. Targeting the IL-23/-17 pathways seems an efficient strategy for treatment of SpA patients, and despite the remaining challenges the pathway holds great promise for further advances and improved therapeutic opportunities. Much research is focusing on serological markers and imaging strategies to correctly diagnose patients in the early stages of SpA. Biomarkers may facilitate personalised medicine tailored to each patient's specific disease to optimise treatment efficacy and to monitor therapeutic response. This narrative review focuses on the IL-17 pathway in SpA-related diseases with emphasis on its role in pathogenesis, current approved IL-17 inhibitors, and the need for biomarkers reflecting core disease pathways for early diagnosis and measurement of disease activity, prognosis, and response to therapy.
Highlights
Spondyloarthritis (SpA) represents a group of related but pheno typically distinct inflammatory autoimmune diseases
Patients diagnosed with reactive arthritis and inflammatory bowel disease (IBD)-associated arthritis often fit into the peripheral SpA (pSpA) category [6] (Fig. 1)
This narrative review will explore the role of IL-17 in homeostasis and its heterogeneous effects in inflammation and structural damage to justify for the potential advantageous effect of IL-17 inhibition in AS and psoriatic arthritis (PsA)
Summary
Spondyloarthritis (SpA) represents a group of related but pheno typically distinct inflammatory autoimmune diseases. SpA includes axial SpA (axSpA, summarizing radiographic (ankylosing spondylitis, AS); =”” axialSpA) and non-radiographic disease, peripheral SpA (pSpA) and psoriatic arthritis (PsA) [1,2]. These subforms of SpA have overlapping clinical features that reflect shared genetic risk factors and pathophys iology. Applying biomarkers to address the many chal lenging aspects of SpA may enhance the development of novel treat ments which may offer more specialised and effective treatment of patients [24] This narrative review will explore the role of IL-17 in homeostasis and its heterogeneous effects in inflammation and structural damage to justify for the potential advantageous effect of IL-17 inhibition in AS and PsA. The review will assess the current challenges in the management of SpA and summarise promising biomarkers of inflam mation and tissue remodelling including parameters of angiogenesis and autoantibodies that may improve the diagnosis, prognosis and treatment outcomes in SpA
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