Journal Article

The bone marrow side of axial spondyloarthritis

Ciccia, Francesco, Gandolfo, Saviana, Tirri, Enrico, Mauro, Daniele, Schett, Georg, Maksymowych, Walter P

2023

Overview

Spondyloarthritis (SpA) is characterized by the infiltration of innate and adaptive immune cells into entheses and bone marrow. Molecular, cellular and imaging evidence demonstrates the presence of bone marrow inflammation, a hallmark of SpA. In the spine and the peripheral joints, bone marrow is critically involved in the pathogenesis of SpA. Evidence suggests that bone marrow inflammation is associated with enthesitis and that there are roles for mechano-inflammation and intestinal inflammation in bone marrow involvement in SpA. Specific cell types (including mesenchymal stem cells, innate lymphoid cells and γδ T cells) and mediators (Toll-like receptors and cytokines such as TNF, IL-17A, IL-22, IL-23, GM-CSF and TGFβ) are involved in these processes. Using this evidence to demonstrate a bone marrow rather than an entheseal origin for SpA could change our understanding of the disease pathogenesis and the relevant therapeutic approach.In this Perspective, the authors discuss molecular, cellular and imaging evidence in spondyloarthritis that supports a bone marrow rather than an entheseal origin. Focusing on immune cells and dysfunction in the bone marrow niche could redirect the therapeutic approach to spondyloarthritis.

• Publisher: Nature Publishing Group
• Subject: Arthritis / Axial skeleton / Bone imaging / Bone marrow / Granulocyte-macrophage colony-stimulating factor / Inflammation / Inflammatory diseases / Interleukin 22 / Interleukin 23 / Joint diseases / Lymphocytes T / Lymphoid cells / Mesenchymal stem cells / Pathogenesis / Rheumatic diseases / Toll-like receptors