Pathogenesis of ankylosing spondylitis and reactive arthritis.
OBJECTIVE
The hallmark of ankylosing spondylitis is acute and chronic spinal inflammation initiating in the sacroiliac joints, often coupled with enthesitis, presenting as chronic inflammation at the sites of ligamentous and tendinous insertions into bone. Peripheral joint synovitis can be a prominent feature as well. Reactive arthritis is a sterile synovitis arising after an extra-articular infection of enteric or urogenital tracts. HLA-B27 has been known for about the past 30 years to be associated with ankylosing spondylitis and reactive arthritis, but the pathogenesis of ankylosing spondylitis and reactive arthritis is still not well defined. Although the clinical manifestations of ankylosing spondylitis and reactive arthritis may differ, this update discusses the two diseases together and focuses on recent evidence in both.


RESULTS
With respect to HLA-B27 several recent studies address arthritogenic peptides, molecular mimicry, and aberrant forms of B27. Several candidate genes in addition to B27 have been implicated in recent genetic studies. With respect to bacterial infection, recent findings in bacterial antigenicity, host response through interactions of antigen-presenting cells, T cells, and cytokines are providing new understanding of host-pathogen interactions and the pathogenesis of arthritis. Endogenous host factors such as proteoglycans may play a role as autoantigens and contribute to chronic inflammation on that basis.


CONCLUSIONS
Recent advances provide additional new insights into distinct pathogenetic mechanisms in AS and ReA that arise from a complex interplay between genetic factors including HLA-B27 and environmental factors.
Kim
Tae-Hwan
TH
The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea.
Uhm
Wan-Sik
WS
Inman
Robert D
RD
D016918:Arthritis, Reactive / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D001424:Bacterial Infections / Q000150:complications / Q000276:immunology; D005819:Genetic Markers; D020022:Genetic Predisposition to Disease; D015796:HLA-B27 Antigen / Q000097:blood / Q000235:genetics; D006801:Humans; D000091402:Prohibitins; D013167:Spondylitis, Ankylosing / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology
D005819:Genetic Markers; D015796:HLA-B27 Antigen; C000717331:PHB2 protein, human; D000091402:Prohibitins