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Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 369202, 6 pages
http://dx.doi.org/10.1155/2013/369202
Review Article

How to Translate Basic Knowledge into Clinical Application of Biologic Therapy in Spondyloarthritis

Division of Allergy-Immunology-Rheumatology, Department of Medicine, Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei 112, Taiwan

Received 7 November 2012; Accepted 24 May 2013

Academic Editor: Jieruo Gu

Copyright © 2013 Chung-Tei Chou. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Spondyloarthritis (SpA) is a family of many diseases, and these diseases share some clinical, genetic, and radiologic features. The disease process in the spine at the beginning is spinal inflammation, in which TNFα is the principal cytokine involved. Therefore, the dramatic clinical and pathologic response of anti-TNFα therapy in SpA is based upon the presence of increased TNFα in synovial tissues and sacroiliac joints, which perpetuates chronic inflammation. The increased Toll-like receptors (TCR) 2 and 4 in the serum, peripheral blood mononuclear cells, or synovial tissues of ankylosing spondyloarthritis (AS) or SpA patients suggest that SpA is highly associated with innate immunity. Any drug including anti-TNFα blocker which can downregulate the TCR, infiltrated neutrophils, or CD163+ macrophages in the synovial tissue is the rationale for the management of SpA. Like rheumatoid arthritis, the increased TH22 and TH17 cells either in blood, synovial fluid, or synovial tissues were also demonstrated in SpA. Thus, TH17 and TH22 may be reasonable cellular targets for therapeutic intervention. Drugs (anti-IL6R or anti-IL6) which can reduce the binding of IL6 and IL6R to the cell surface may be beneficial in SpA. Many proteins are implicated in the new bone formation (syndesmophyte) or ankylosis in AS or SpA. The enhanced BMP and Wnt pathway will activate osteoblasts which promote the new bone formation. However, no drug including anti-TNFα can stop or prevent the syndesmophyte in AS. In summary, looking for new targeting therapies for either anti-inflammation (beyond anti-TNF) or anti-bone formation (including anti-TGFβ or PDGF) is warranted in the future.