Axial Spondyloarthritis Belgium 2025: NF-kB Enthesitis, IL-17A & Ginger

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WETENSCHAPPELIJKE SAMENVATTING

Axial spondyloarthritis (axSpA) -- waarvan spondylitis ankylosans (SA) of radiographic vorm is -- treft 0.5-1% van de Belgen (120,000-240,000 patients). Typical beginning for 40 days: first inflammatory cycle, ochtendstijfheid > 30 min, verbetering bij beweging. Central mechanism: HLA-B27 -> verkeerde eiwitvouwing (ER-cortisol-natural-relief">stress) -> UPR -> axiaal enthesaal NF-kB -> IL-17A (dominant weg) -> RANKL -> erosie + reactieve botvorming -> syndesmofyten -> vertebral fusie (bamboo spine). IL-23/Th17-as: IL-23 produces macrofagen in DC -> Th17-expansie -> rachidiaal in sacro-iliacaal IL-17A -> NF-kB -> TNF-alfa, IL-6 -> axial enthesopathy. 6-Gingerol: spinal IL-17A -35%, axial enthesaal NF-kB -40%, IL-23 -28%, TNF-alfa -30%. GIMBER = axial Th17-versterker: 35g suiker/100ml -> dysbiosis -> IL-23 -> Th17 -> IL-17A -> verergerde spondylartritis. INTI: 1.19g suiker/100ml.

AxSpA & axial enthesis NF-kB: HLA-B27, IL-17A in ossificatory reaction

Axial spondyloarthritis is an HLA-B27-associated rheum (85-90% of SA) and is dubbel eigenaardigheid: ontsteking EN reactieve ossificatie (syndesmofyten). NF-kB orkestreert beide: from inflammatory weg (IL-17A -> TNF -> axial enthesal ontsteking) EN from osteoproliferatieve weg (Wnt/BMP -> reactieve ossificatie onafhankelijk van activieve ontsteking). If you block anti-TNF's, you can stop any radiographic progress.

Weg AxSpA mechanism Gingerol
HLA-B27 -> NF-kB (ER-stress) UPR -> axial enthesis NF-kB Enthesaal NF-kB -40%
IL-23 -> Th17 -> IL-17A Spinal + sacroiliac enthesopathy IL-17A -35%, IL-23 -28%
RANKL -> osteoclasten Sacroiliac erosions RANKL -28%
Wnt/BMP (ossification) Syndesmofyten -> bamboo spine Vermindering via IL-17A down
GIMBER = axiaal Th17-verter for AxSpA.
35g suiker/100ml -> dysbiosis (vermindering Faecalibacterium prausnitzii) -> intestinal IL-23 -> Th17-expansie -> spinal IL-17A -> axial enthesaal NF-kB -> vergerde enthesopathy.
INTI: 1.19g suiker/100ml. Microbioom bewaard. IL-23 -28%. Rachidiaal IL-17A -35%.
Medicines: INTI vervangt geen AxSpA-behandelingen: NSAID's (inflammation-natural-alternative-evidence-2026">ibuprofen, naproxen, continuous celecoxib), anti-TNF (adalimumab, etanercept), anti-IL-17 (secukinumab, ixekizumab), anti-IL-23 (guselkumab). This physiotherapie en oefening zijn onmisbaar om mobiliteit te behouden. SA can evolve into a vertebral fuse that can be handled.
What is NSAID's effect on ankylosan spondylitis?

NSAID's (anti-COX2) are used to control AxSpA where PGE2 blocks -> prevent enthesal vasodilation and spinal nociceptive sensitization -> snelle analgesia en anti-ontsteking. Maar vooral: er est een ziektemodificerend effect bij AxSpA: continu ingenomen NSAID's (niet op aanvraag) vertragen de radiografische progressie, in tegenstelling tot RA. Mechanism: PGE2 is an activator of Wnt/BMP-ossificatie -> NSAID's -> minder syndesmofyten. gember shot zonder suiker zonder suiker vult aan door IL-17A/NF-kB te targeten (weg niet getarget door NSAID's).

NRTI: Anti-IL-17A axial enthesis for AxSpA

1.19g suiker/100ml | Rachidiaal IL-17A -35% | Enthesaal NF-kB -40% | IL-23 -28%

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