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主要以带为中心的软组织参与区分了轴性牛皮关节炎和结性脊柱炎

Dennis McGonagle¹, Paula David², Tom Macleod²

¹Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK. D.G.McGonagle@leeds.ac.uk.

Nature reviews. Rheumatology

|November 3, 2023

概括

化脊柱炎 (AS) 和轴性牛皮关节炎 (PsA) 显示出不同的骨和软组织炎症模式. HLA-B27基因携带影响AS的骨质炎,而PsA涉及更多的带变化,影响治疗反应.

科学领域:

类风湿病学类风湿病学
免疫学免疫学免疫学
放射学放射学是一门学科.

背景情况:

脊椎关节炎包括诸如结性脊椎炎 (AS) 和轴性牛皮关节炎 (PsA) 等疾病.
他们的轴向表现的相似性和差异已经在50多年里被观察到.
了解这些区别对于诊断和治疗至关重要.

研究的目的:

描述AS和轴性PSA之间的关键解剖学和免疫学差异.
在轴性脊柱关节炎中识别与HLA-B27携带相关的成像表型.
探索这些差异如何影响治疗反应,特别是对IL-23的抑制.

主要方法:

现有文献和临床观察对AS和轴性PSA的临床观察的审查.
分析图像检测结果 (MRI,X光) 相关的肠炎和骨参与.
遗传因素 (HLA-B27) 与特定的炎症模式的相关性.

主要成果:

在轴性疾病中,HLA-B27阳性与周围纤维软骨质神经关节骨质炎和广泛的脊柱周围肠道骨质炎有关.
在HLA-B27+轴性疾病中,明显的骨表型包括骨髓,脂肪角,神经炎,脊椎方形和罗曼氏病变.
轴性PsA经常显示"带炎"与para-syndesmophytes和神经关节骨节省,不同于AS.
扩散性异常性骨高静止症 (DISH) 与轴性PsA共享软组织热带,具有综合性植物症和准脊椎骨化.

结论:

HLA-B27状态是轴性脊柱关节炎骨表型的关键差异化因素.
骨和软组织在AS与轴性PsA中的明显参与表明了不同的潜在病理生物学.
肠骨和软组织组成的差异可能解释了对IL-23抑制剂等免疫调节疗法的不同反应.

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