Abstract
Emerging evidence suggests there is a gut-joint axis in spondyloarthritis (SpA). In a study, subclinical gut inflammation occurred in nearly 50% of SpA. Chronic gut inflammation also correlated with disease activity in SpA. Trillions of microorganisms reside in the human gut and interact with the human immune system. Dysbiosis affects gut immune homeostasis and triggers different autoimmune diseases including SpA. The absence of arthritis in HLA-B27 germ-free mice and the development of arthritis after the introduction of commensal bacteria to HLA-B27 germ-free mice proved to be the important role of gut bacteria in shaping SpA, other than the genetic factor. The recent advance in gene sequencing technology promotes the identification of microorganisms. In this review, we highlighted current evidence supporting the link between gut and axial SpA (axSpA). We also summarized available findings of gut microbiota and its interaction with the immune system in axSpA. Future research may explore the way to modulate gut microorganisms in axSpA and bring gut microbiome discoveries towards application.
Highlights
Spondyloarthritis (SpA) is a common chronic inflammatory disease with a disease prevalence of 0.2% to 1.6% [1]
We focus on the current understanding of the relationship between gut and axial SpA (axSpA) and explore the potential use of microbiota in treating axSpA
This suggests that overexpression of HD-5 and proinflammatory cytokines such as IL-23 may be involved in the pathogenesis of an early stage of Ankylosing spondylitis (AS) and Crohn’s disease (CD) [21], followed by reduction in defensin, leading to bacterial translocation and inflammatory responses
Summary
Spondyloarthritis (SpA) is a common chronic inflammatory disease with a disease prevalence of 0.2% to 1.6% [1]. It mainly affects young people, with around 90% of them developing symptoms before 40 years old [2]. Patients often have extra-articular manifestations including psoriasis, uveitis and inflammatory bowel disease (IBD). Bacteroidetes and Firmicutes are the two major phyla, which account for nearly 90% of the microbes identified in the gastrointestinal tract, whereas Actinobacteria, Proteobacteria and Verrucomicrobia have a lower abundance [6]. Healthy individuals have high diversity concerning gut microbiome composition of Bacteriodetes, Firmicute, Actinobacteria, Spirochetes and Proteobacteria phyla. Gut inflammation was associated with increased risk of evolution from non-radiographic axSpA to AS and increased risk of IBD [18]. We focus on the current understanding of the relationship between gut and axSpA and explore the potential use of microbiota in treating axSpA
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