Gut microbiota mediator level and its relation to disease activity in ankylosing spondylitis

Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease that affects the axial skeleton, causes characteristic inflammatory lower back pain, and can lead to structural and functional disorders. It is known that the intestinal microbiota plays an important role in the development of many diseases. In this study, we evaluated the relationship between gut microbiota markers and clinical parameters of AS disease and the effect of drugs on gut microbiota markers. This study included 76 AS patients diagnosed for at least 2 years, aged between 18-65 (38 anti-TNF recipients-38 NSAIs recipients), and 38 age- and sex-matched healthy volunteers. Detailed clinical evaluations were made in patients and volunteers. Erythrocyte sedimentation rate (ESR) and C-Reactive Protein (CRP) were measured in patients and volunteers, BASDAI and BASFI scores were also calculated and recordedin the patient group. CD14, CTLA4, CXC16, LPS and TLR4 levels were measured in serum samples using the ELISA method. When BASDAI and BASFI scores were compared between patients receiving anti-TNF therapy and NSAI therapy, BASDAI and BASFI scores were found to be significantly higher in NSAI recpient group (p˂0.05). When CRP and ESR levels were compared between AS groups, it was found that patients who received anti-TNF therapy were significantly lower than those who received NSAI therapy (p˂0.05). When the intestinal microbiota markers were evaluated between the patients receiving anti-TNF therapy and NSAI therapy and the control group; CTLA4, CXC16, LPS and TLR4 levels were found to be statistically significantly higher in the AS group receiving NSAI treatment compared to the AS group receiving anti-TNF treatment and the healthy control group (p˂0.05). CD14 levels were found to be statistically insignificant between the groups (p>0.05. Studies have shown that intestinal inflammation occurs in AS patients and affected by the microbiota. In our study, it was observed that CRP and ESR levels and disease activity scores in AS patients who received anti-TNF treatment were lower than those of the NSAI treatment group and even closer to the control group. These results show that Anti-TNF therapy is more effective in AS on viii intestinal microbiota markers, and clinical and inflmammation parameters. We think that the relationship of gut microbiota markers with clinical and inflammation markers may be an indicator in the pathogenesis of AS and the follow-up of a treatment and may contribute to new treatment strategies.