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Pathogenesis of Axial Spondyloarthritis - Sources and Current State of Knowledge


Joerg Ermann 1

Rheum Dis Clin North Am. 2020 May;46(2):193-206. doi: 10.1016/j.rdc.2020.01.016

Author Information

  • 1Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, HBTM, Room 06002P, 60 Fenwood Road, Boston, MA 02115, USA. Electronic address: jermann@bwh.harvard.edu.


Scientific breakthroughs have culminated in the development of the spondyloarthritis (SpA) concept as a family of rheumatic diseases, distinct from rheumatoid arthritis. The demonstration of inflammatory lesions in the sacroiliac joints and spine of patients with axial symptoms of SpA who lacked radiographic features of ankylosing spondylitis (AS) helped refine the SpA concept. Axial SpA includes patients with AS and patients with axial symptoms previously categorized as undifferentiated SpA. This review examines the sources of knowledge that inform axial SpA pathogenesis, highlighting current limitations, and a basic working model of axial SpA pathogenesis.