Loss and gain of bone in spondyloarthritis: what drives these opposing clinical features?

Gavin Clunie, Nicole Horwood

Research output: Contribution to journalReview articlepeer-review

19 Citations (Scopus)
14 Downloads (Pure)


The breadth of bone lesion types seen in spondyloarthritis is unprecedented in medicine and includes increased bone turnover, bone loss and fragility, osteitis, osteolysis and erosion, osteosclerosis, osteoproliferation of soft tissues adjacent to bone and spinal skeletal structure weakness. Remarkably, these effects can be present simultaneously in the same patient. The search for a potential unifying cause of effects on the skeleton necessarily focuses on inflammation arising from the dysregulation of immune response to microorganisms, particularly dysregulation of TH17 lymphocytes, and the dysbiosis of established gut and other microbiota. The compelling notion that a common antecedent pathological mechanism affects existing bone and tissues with bone-forming potential (entheses), simultaneously with variable effect in the former but bone-forming in the latter, drives basic research forward and focuses our awareness on the effects on these bone mechanisms of the increasing portfolio of targeted immunotherapies used in the clinic.

Original languageEnglish
Pages (from-to)1-17
Number of pages17
JournalTherapeutic Advances in Musculoskeletal Disease
Early online date30 Oct 2020
Publication statusPublished - 1 Jan 2021


  • ankylosing spondylitis (AS)
  • axial spondyloarthritis (axSpA)
  • bone pathophysiology
  • enthesophyte
  • osteoimmunology
  • osteomicrobiology
  • osteoporosis
  • osteoproliferation
  • spondyloarthritis (SpA)
  • syndesmophyte

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