Ankylosing spondylitis articles from across Nature Portfolio

This Evidence-Based Guideline presents the first Pan American League of Associations for Rheumatology recommendations for the management of axial spondyloarthritis, addressing therapeutic targets, the use of pharmacological and non-pharmacological interventions and monitoring of patients.

In this Perspective, the authors discuss molecular, cellular and imaging evidence in spondyloarthritis that supports a bone marrow rather than an entheseal origin. Focusing on immune cells and dysfunction in the bone marrow niche could redirect the therapeutic approach to spondyloarthritis.

The World Health Organization (WHO) has published new guidelines for the non-surgical management of chronic primary low back pain in adults in primary and community care settings. Although the guidelines are commendable, they lack guidance on when to suspect and how to avoid missing important secondary causes of back pain.

Biosimilars have an important place in the treatment of rheumatic conditions. The non-inferiority of biosimilars to bio-originators is ensured, but full and effective clinical adoption of these agents nonetheless requires consideration of several important issues, including the need for shared decision-making and a potential nocebo effect.

In screening for post-translational modifications associated with ankylosing spondylitis, researchers have identified a microbiome-metabolite-mediated modification that can lead to neoantigen generation and subsequent autoimmunity.

The mechanosensitive ion channel Piezo1 is involved in pathogenic new bone formation in entheseal tissues in ankylosing spondylitis.

The mechanisms underlying the genetic association between HLA-B27 and ankylosing spondylitis, including the contribution of endoplasmic reticulum aminopeptidase 1 (ERAP1), continue to elude the field. New findings support the involvement of the unfolded protein response and highlight the therapeutic potential and limitations of targeting ERAP1 in this disease.