Pathogenic role of gut inflammation in the spondyloarthropathies

Some of today's most exciting immunologic research relevant to the pathogenesis of spondyloarthropathies concerns the relationship between the host immune system in the gut and in the intestinal bacteria. Through transgenic and gene knockout studies in rodents and the development of appropriate experimental models, it has become clear that this relationship depends on a fine balance in the production of different cytokines. Surprisingly, HLA-B27, acting at the level of T-cell recognition, disturbs this balance in ways that promote the development of arthritis. Exploring the mechanism of this disturbance and the role of genes other than B27 promises to illuminate the connection between gut inflammation and spondyloarthropathy--which has been carefully documented by clinicians over the past 30 years.