Pathogenesis, Clinical Spectrum, and Assessment of Spondyloarthritis: A Literature Review

Kaiser Gerald Handoyo¹, Awalia^2*

Abstract

Spondyloarthritis (SpA) is a family of chronic inflammatory rheumatic diseases that share inflammatory back pain, sacroiliitis, peripheral arthritis, enthesitis, dactylitis, extra-articular involvement, absence of rheumatoid factor, and a strong association with HLA-B27. Its presentation varies between patients and subtypes, and this variability can delay diagnosis by several years. This narrative review summarizes the pathogenesis, clinical spectrum, classification, and assessment of SpA. HLA-B27 may promote disease through the presentation of arthritogenic peptides, protein misfolding with endoplasmic reticulum stress, and the formation of heavy-chain homodimers. Mechanical stress at the entheses, gut dysbiosis, and adipokines released by excess adipose tissue add to the inflammatory load. These pathways converge on the interleukin-23/interleukin-17 axis and tumor necrosis factor-alpha, which sustain inflammation in the entheses and bone marrow, cause trabecular bone loss, and later favor new bone formation through Wnt and bone morphogenetic protein signaling. Ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and arthritis associated with inflammatory bowel disease remain the classic subtypes, which the Assessment of SpondyloArthritis International Society (ASAS) now groups into axial and peripheral forms. Beyond the spine and joints, SpA can affect the eyes, heart, lungs, kidneys, liver, and gallbladder. Reported frequencies vary between cohorts, and Indonesian data come from small single-center series. ASAS classification criteria, inflammatory markers, the complete blood count, and the Ankylosing Spondylitis Disease Activity Score provide a structured framework for recognition and follow-up. Multicenter studies should now define the clinical pattern of SpA in Indonesia.

Keywords

spondyloarthritis; HLA-B27; enthesitis; sacroiliitis; ASAS classification criteria; ASDAS

Cite This Article

Handoyo, K. G., Awalia,. (2026). Pathogenesis, Clinical Spectrum, and Assessment of Spondyloarthritis: A Literature Review. International Journal of Scientific Advances (IJSCIA), Volume 7| Issue 5: Sep – Oct 2026, Pages 757-766. URL: https://www.ijscia.com/wp-content/uploads/2026/10/Volume7-Issue5-Sep-Oct-No.1097-757-766.pdf

Volume 7 | Issue 5: Sep – Oct 2026