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Contemplating bone damage in patients with PsA

Pathogenic processes leading to bone damage in PsA

Bone Damage in PsA

In PsA, the inflammatory processes and new bone formation take place in the entheses, axial skeleton, and peripheral joints via the cytokine pathways, which are only just starting to be understood.2 Data suggests that bone erosion and new bone formation in PsA may occur simultaneously at different anatomical sites, with IL-17 playing a complex role in these immune-mediated processes.1

Addressing bone changes in PsA

The underlying processes leading to bone damage in PsA need to be understood and addressed in order to improve clinical outcomes for patients. The loss of existing bone and new bone formation are highly relevant to overall burden of disease, including clinical manifestations, disability, and long-term outcomes, such as spinal fracture.3

In addressing bone pathophysiology, it is important to focus on robust clinical measures of both bone loss in vertebrae and of the drivers of osteoproliferation. This will help achieve the ultimate goal of developing therapeutic approaches to reducing osteitis/erosion, bone turnover, and osteoproliferation to fully enable improved long-term skeletal outcomes.3

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  1. McGonagle DG, McInnes IB, Kirkham BW, et al. The role of IL-17A in axial spondyloarthritis and psoriatic arthritis: recent advances and controversies [published correction appears in Ann Rheum Dis. 2020;79(1):e12]. Ann Rheum Dis. 2019;78(9):1167-1178. doi:10.1136/annrheumdis-2019-215356
  2. Groen SS, Sinkeviciute D, Bay-Jensen AC, et al. Exploring IL-17 in spondyloarthritis for development of novel treatments and biomarkers. Autoimmun Rev. 2021;20(3):102760. doi:10.1016/j.autrev.2021.102760
  3. Clunie G, Horwood N. Loss and gain of bone in spondyloarthritis: what drives these opposing clinical features?. Ther Adv Musculoskelet Dis. 2020;12:1759720X20969260. Published 2020. doi:10.1177/1759720X20969260