Mohammad Hossein Nicknam - Ankylosing Spondylitis - Axial Spondyloarthritis: Cellular, Molecular and Environmental Factors

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In the name of God.

the compassionate, the merciful.

The spondyloarthropathies are a group of chronic autoimmune disorders including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease-associated spondyloarthropathy, and undifferentiated spondyloarthropathies affecting the spine, large joints, tendons, and small joints in progressive forms.

The prevalence of ankylosing spondylitis, the most common spondyloarthropathy, is approximately 0.20.5% in different populations. AS mainly affects young adults causing considerable social and economic damage to their lives, rendering them disabled at older ages if not treated properly.

Despite substantial clinical advances in managing the patients suffering from spondyloarthropathies, the molecular aspects of pathogenesis and the genetic basis of the disease remain mostly unexplained. The most known genetic feature of spondyloarthropathies is HLA-B27 positivity whose contribution to the pathogenesis is still under study and surrounded by unproven hypotheses. Therefore, it is essential to discuss and expand our knowledge about the molecular basis of the pathogenesis of spondyloarthropathies in order to improve diagnosis methods, treatment quality, and preventive strategies for reducing the burden of disease. It might also pave the way for designing more efficient therapeutic agents.

In the present book, we have described the molecular and immunological aspects of spondyloarthropathies in eight elaborated chapters including the detailed role of innate and adaptive immunity, HLA and non-HLA genes, and finally, participation of the environmental factors in disease initiation and progression. Regarding the significance of gut microbiota, nutritional factors as well as mechanical stress in the pathogenesis of spondyloarthropathies, and considering the fact that the environmental risk factors might be more plausible to manipulate than inherent factors, the last chapters could be of special interest for researchers.

Paleopathological studies of Egyptian mummies have shown that the disease, Ankylosing Spondylitis (AS) , has been affecting human beings since ancient times [].

Ankylosing spondylitis mainly affects young people (late adolescence and early adulthood) ranging from 12 to 45 years old. The mean age at disease onset is estimated to be between 23 and 31 years old, which has been shown to increase during recent years, especially in developed countries [].

AS has generally been known as a male sex disease according to the former studies indicating nine times more prevalence among men compared to the women [].

Genetic factors considerably affect the ethnic distribution of SpA. The best example of this could be the HLA-B27 gene which is assumed as a predictive risk factor for AS []. Probable mechanisms of HLA-B27 predisposing role and different subtypes association with the disease will be discussed in other chapters.