Tumour necrosis factor blockers and structural remodelling in ankylosing spondylitis: what is reality and what is fiction?
نویسندگان
چکیده
A hallmark of spondylarthropathies (SpA), such as ankylosing spondylitis, (AS) is the fusion of joints as well as intervertebral spaces. This fusion is caused by the formation of bony spurs appearing as syndesmophytes and osteophytes in the intervertebral spaces and in the joints, respectively. Fusion of joints is based on increased endochondral ossification, which allows bone formation and bridges the joint space. Tumour necrosis factor (TNF) is a key proinflammatory cytokine in AS, but is a potent inhibitor of bone formation, and so is unlikely to explain the formation of osteophytes in AS. This is also suggested by recent clinical data showing that TNF blockade seems not to affect structural remodeling of the spinal skeleton in AS, which largely indicates changes due to increased bone apposition. Thus, molecular concepts of structural remodelling in AS need revision, and new pathways involved in bone formation, such as Wingless proteins or transforming growth factor b, might be a clue to the pathogenesis of structural remodelling in AS. The efficacy of TNF blockers to improve clinical symptoms in AS, their poor effect on structural remodelling, and the weak relationship between clinical symptoms and structural damage in AS will profoundly revise our picture of AS in the future.
منابع مشابه
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ورودعنوان ژورنال:
- Annals of the rheumatic diseases
دوره 66 6 شماره
صفحات -
تاریخ انتشار 2007