PATHOGENESIS OF PSORIATIC ARTHRITIS

Nastanak psorijatičnog artritisa povezuje se s genetskim i imunosnim čimbenicima te čimbenicima okoliša. Psorijaza i psorijatični artritis povezani su s alelima MHC-a razreda I; psorijaza s HLA-C*06, a psorijatični artritis s HLA-B*08, B*27, B*38 i B*39. Prirođena i stečena imunost pridonose patogenezi psorijatičnog artritisa. Ključni citokini u patogenezi psorijatičnog artritisa jesu IL-12/23, IL-17A i TNF-α zbog čega je dosadašnje liječenje usmjereno prema njihovoj blokadi. Erozije kosti posredovane su signalnim putovima NF-κB, IL-17 i RANKL. Recentne studije naglašavaju biomehaničko naprezanje tetiva i mikrotraumu kao inicijalne faktore upale. Supklinička upala crijeva i disbioza crijevnog mikrobioma također su mogući pokretači bolesti. Dosadašnje spoznaje o ključnim molekulama u patogenezi psorijatičnog artritisa otvaraju putove novim istraživanjima i mogućnostima liječenja.Th e occurrence of psoriatic arthritis is associated with genetic, immune, and environmental factors. Psoriasis and psoriatic arthritis are associated with MHC class I gene alleles; psoriasis with HLA-C*06, and psoriatic arthritis with HLA-B*08, B*27, B*38, and B*39. Both innate and adaptive immunity contribute to the pathogenesis of psoriatic arthritis. Key cytokines in the pathogenesis of psoriatic arthritis are IL 12/23, IL 17A, and TNFα, which is why current treatment aims at blocking them. Bone erosions are mediated by NF-κB, IL-17, and RANKL signaling pathways. Recent studies emphasize biomechanical stress on tendons and microtrauma as initial factors of infl ammation. Subclinical gut infl ammation and microbial dysbiosis are possible triggers of disease, too. Recently acquired knowledge about key molecules in the pathogenesis of psoriatic arthritis will lead to new investigations and treatment opportunities