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Bone Involvement in Patients with Spondyloarthropathies
Willem Lems1, Corinne Miceli-Richard2,3, Judith Haschka4,5
1Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands. wf.lems@amsterdamumc.nl.
Calcified Tissue International
|January 23, 2022
Summary
Spondyloarthropathies (SpA) involve bone loss and new bone formation, like syndesmophytes. Current treatments reduce inflammation but don't inhibit syndesmophyte growth, necessitating further research into pathogenesis and targeted therapies.
Area of Science:
- Rheumatology
- Bone Biology
- Inflammatory Diseases
Background:
- Spondyloarthropathies (SpA) are inflammatory rheumatic diseases causing bone loss and vertebral fractures.
- SpA also features new bone formation in the spine (syndesmophytes).
- Current treatments like TNF inhibitors (TNFi) and IL-17 inhibitors (IL-17i) reduce inflammation but fail to inhibit syndesmophyte formation.
Purpose of the Study:
- To unravel the pathogenesis of syndesmophyte formation and growth in SpA.
- To evaluate new diagnostic and therapeutic options for SpA bone involvement.
- To provide a comprehensive review for basic scientists and clinicians.
Main Methods:
- Review of existing literature on SpA, bone metabolism, and treatment outcomes.
- Analysis of risk factors for radiographic progression in axial SpA (axSpA).
- Evaluation of diagnostic techniques including MRI, low-dose CT, and 18F-fluoride PET-scans.
Main Results:
- Radiographic progression in axSpA is linked to male sex, smoking, HLA-B27, elevated CRP, syndesmophytes, and MRI inflammation.
- TNFi and IL-17i reduce inflammation and symptoms but do not consistently inhibit syndesmophyte formation.
- Advanced imaging (low-dose CT, MRI, PET) and bone turnover markers show promise for early detection and monitoring.
Conclusions:
- More insight into the pathogenesis of bone formation in axSpA is needed.
- Targeted therapies are required to prevent syndesmophyte formation.
- Early detection using advanced imaging and risk factor assessment is crucial for managing SpA bone complications.
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