Differential Effects of Inflammation on Bone and Response to Biologics in Rheumatoid Arthritis and Spondyloarthritis

  • Zheni Stavre
  • Katherine Upchurch
  • Jonathan Kay
  • Ellen M. Gravallese
Spondyloarthritis (M Khan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Spondyloarthritis


Purpose of review

We review the pathways, cytokines, and concepts important to the pathogenesis of bone resorption and formation in rheumatoid arthritis (RA) and spondyloarthritis (SpA).

Recent findings

Research in bone biology has shed light on the pathogenesis of the joint destruction that occurs in RA and in peripheral SpA. However, understanding the mechanisms behind the bone formation seen in peripheral and axial SpA has been challenging. Mouse models have been used to gain an understanding of key signaling pathways, cytokines and cells regulating inflammation in these diseases. Biologic therapies directed against these targets have been developed to control both inflammation and effects on bone.


Although biologic therapies improve joint inflammation in both RA and SpA, leading to a decrease in pain and improving quality of life for patients, the long-term effects of such therapies must also be evaluated by assessing their impact on structural progression. Inhibition of radiographic progression in both RA and peripheral SpA has been easier to demonstrate than in axial SpA. Here, we discuss the similarities and differences among biologic therapies as they pertain to radiographic progression.


Rheumatoid arthritis Spondyloarthritis Bone Biologics Radiographic imaging 


Compliance with Ethical Standards

Conflicts of Interest

EG reports grants from AbbVie Inc, personal fees from AbbVie Inc, Eli Lilly and Company, GlaxoSmithKline PLC, Novartis Pharmaceuticals Corporation, Sanofi, and UpToDate.

JK reports grants and personal fees from AbbVie Inc, Genentech Inc, GlaxoSmithKline PLC, UCB Inc, Eli Lilly and Company, Pfizer Inc, Roche Laboratories Inc, personal fees from Amgen, Inc, Boehringer Ingelheim GmbH, Bristol-Myers Squibb Company, Crescendo Bioscience Inc, Epirus Biopharmaceuticals Inc, Hospira Inc, Janssen Biotech Inc, Merck Sharp & Dohme Corp, Novartis Pharmaceuticals Corporation, Regeneron Pharmaceuticals Inc, Samsung Bioepis, Sandoz Inc, and UpToDate.

KU and ZS declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any primary studies with human or animal subjects performed by the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Zheni Stavre
    • 1
    • 2
  • Katherine Upchurch
    • 1
    • 2
  • Jonathan Kay
    • 1
    • 2
  • Ellen M. Gravallese
    • 1
    • 2
  1. 1.Department of Medicine, Division of RheumatologyUMass Memorial Medical CenterWorcesterUSA
  2. 2.University of Massachusetts Medical SchoolWorcesterUSA

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