Ankylosing spondylitis: an autoimmune or autoinflammatory disease?

Area of Science:

• Immunology
• Rheumatology
• Pathophysiology

Background:

• Ankylosing spondylitis (AS) is a chronic inflammatory disease with unknown causes.
• AS pathogenesis involves the innate immune system, with aberrant activity in immune cells like γδ T cells and neutrophils.
• The intestine and biomechanical factors at entheses are implicated in AS development.

Purpose of the Study:

• To review evidence supporting both autoinflammatory and autoimmune components in Ankylosing spondylitis.
• To discuss pathophysiological factors contributing to each hypothesis.
• To reconcile the autoinflammation and autoimmunity concepts in AS.

Main Methods:

• Literature review of studies on Ankylosing spondylitis pathogenesis.
• Analysis of evidence for innate immune system involvement.
• Examination of data supporting autoimmune mechanisms, including autoantibodies and T cell activation.

Main Results:

• The innate immune system plays a dominant role in AS, with specific immune cells showing aberrant activity.
• Evidence suggests an autoimmune component, with autoantibodies and T cell responses identified.
• Both autoinflammatory and autoimmune factors are present in AS pathogenesis.

Conclusions:

• Ankylosing spondylitis exhibits characteristics of both autoinflammation and autoimmunity.
• Understanding the interplay between innate immunity and autoimmune responses is crucial for AS.
• Reconciling these hypotheses offers a more comprehensive view of AS pathophysiology.