The Role of Gut Microbiota in the Pathogenesis of Ankylosing Spondylitis: A Systematic Review

Introduction: Understanding the role of gut microbiota in the pathogenesis of ankylosing spondylitis (AS) is of paramount clinical importance, as it offers novel insights into the systemic nature of this inflammatory disease beyond the axial skeleton. Elucidating the gut-joint axis may uncover microbial biomarkers and therapeutic targets, enabling earlier diagnosis, personalized treatment strategies, and potentially disease-modifying interventions that address underlying immune dysregulation rather than merely suppressing symptoms.Material and methods: This systematic review rigorously synthesized current evidence on gut microbiota’s role in ankylosing spondylitis by screening multiple databases, applying strict inclusion criteria, and following PRISMA guidelines. Data extraction and risk of bias assessments were performed independently to ensure reliability. Clinical and methodological heterogeneity across studies was carefully evaluated, with statistical analyses and subgroup assessments employed to interpret variability, ultimately providing a comprehensive, high-quality appraisal of the gut-joint axis in AS pathogenesis.Results: The results of this systematic review, synthesized from nine eligible studies, reveal consistent alterations in gut microbiota composition among patients with ankylosing spondylitis. Notable findings include increased abundance of Prevotella and Lactobacillus species and reduced levels of Faecalibacterium and Ruminococcus. These microbial changes were associated with elevated pro-inflammatory cytokines (IL-۱۷, IL-۲۳), increased zonulin levels, and reduced butyrate, suggesting a link between dysbiosis, impaired gut barrier function, and systemic inflammation in AS.Conclusion: Based on the synthesized evidence, ankylosing spondylitis is associated with gut microbiota dysbiosis characterized by increased Prevotella and reduced Faecalibacterium, alongside elevated pro-inflammatory, intestinal permeability markers. These findings suggest a gut–immune axis contributing to disease pathogenesis.

کلیدواژه ها:

ankylosing spondylitis ، Gut microbiota ، Intestinal Permeability ، Microbiome ، Immune Interaction