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Syndesmophyte Growth in Ankylosing Spondylitis: from Laboratory to Bedside

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Abstract

Purpose of Review

This study aims to review recent studies on risk factors for syndesmophyte growth in ankylosing spondylitis (AS) and on treatment effects.

Recent Findings

New genetic studies, including a genome-wide association study, provided only limited evidence of specific genetic associations with radiographic severity. Measures of inflammation, including vertebral osteitis and C-reactive protein level, were strongly associated with radiographic progression, while studies of adipokines had mixed results. Mesenchymal stem cells from HLA-B27 positive AS patients were found to promote vertebral ossification via a pathway of B27 misfolding, retinoic acid receptor-β activation, and increased bone alkaline phosphatase. Low vertebral trabecular bone density is associated with syndesmophyte growth, with reciprocal effects when bridged. Several observational studies suggested radiographic severity was reduced by treatment with tumor necrosis factor inhibitors, particularly when longer than 2 years.

Summary

Syndesmophyte development in AS is the result of a complex, incompletely understood, interplay of inflammatory and mechanical factors.

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  1. Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 10CRC, Room 4-1339, 10 Center Drive, Bethesda, MD, 20892, USA

    Michael M. Ward & Sovira Tan

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Correspondence to Michael M. Ward.

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This work was supported by the Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases. Neither author has any conflicts of interest related to this work.

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Ward, M.M., Tan, S. Syndesmophyte Growth in Ankylosing Spondylitis: from Laboratory to Bedside. Curr Rheumatol Rep 25, 119–127 (2023). https://doi.org/10.1007/s11926-023-01104-x

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