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척추관절염의 개념 및 개관

The Concept and Overview of Spondyloarthritis

백한주|서미령
대한내과학회 (The Korean Association Of Internal Medicine)|2013.09|대한내과학회지 (The Korean Journal of Medicine)|제85권 제3호|pp. 229-239|DOI http://dx.doi.org/10.3904/kjm.2013.85.3.229

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참고문헌

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강직성 척추염Ankylosing spondylitisSpondyloarthritisHLA-B27척추관절염Inflammatory back pain염증성 등통증
주제분류내과학

초록

척추관절염은 천장관절염/척추염, 소수관절염, 부착부염같은 근골격 증상과 포도막염, 건선, 장점막 질환 및 HLA-B27 유전자와의 연관성을 공유하고 있는 만성 염증성 류마티스질환이다. 척추관절염의 진단기준은 없지만 다양한 분류기준이 진단에 도움을 줄 수 있다. 최근 ASAS는 방사선학적천장관절염이 보이지 않는 단계를 포함하여 포괄적이고 체계적으로 척추관절염을 분류할 수 있는 축형 및 말초형 척추관절염 분류기준을 제안하였다. 척추관절염은 유전 요소가 지배적인 질환이며 가장 강력한 연관 유전자는 HLA-B27 이다. 최근 MHC 유전자 자리 바깥에 위치한 질환 감수성 유전자로 ERAP1, IL23R 등이 발견되었다. 척추관절염의 주요병리는 부착부의 염증과 골생성이다. 척추관절염의 염증 발생을 설명하기 위해 HLA-B27과 관련된 여러 기전이 제안되었다. HLA-B27 이외의 질환 감수성 유전자 생성물들은HLA-B27 분자의 과정이나 시토카인 경로에 관여할 것으로추정된다. 한편 척추관절염의 골생성을 조절하는 염증 과정과는 완전히 혹은 부분적으로 분리된 기전이 존재한다.

Abstract

The spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic diseases in association with HLA-B27. They share the clinical features including sacroiliitis, spondylitis, oligoarthritis, enthesitis and extra-articular involvement. Recently ASAS proposed new classification criteria sets of axial and peripheral SpA. They were designed to include non-radiographic SpA, thus can guide the early diagnosis of disease before the structural damage occurs. SpA has a strong genetic predisposition. Non-MHC genes, such as IL23R and ERAP1, as well as HLA-B27 were confirmed as susceptibility genes through several GWAS. Major pathology in SpA is entheseal inflammation and new bone formation. Intrinsic ability of HLA-B27 to trigger innate immune response and several proinflammtory cytokines may contribute to the inflammation in SpA. New bone formation could be explained by a mechanism, partly or completely independent of the inflammatory process.

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