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This has implications both for early diagnosis and for effective management. Recently, alterations in the intestinal microbiome have been implicated in disease pathogenesis. In this review, we summarize studies assessing the intestinal microbiome in AS pathogenesis, in addition to synthesizing the literature exploring the postulated mechanisms by which it exerts it pathogenic potential. Finally, we review studies analysing manipulation of the microbiome as a potential therapeutic avenue in AS management.<\/jats:p>","DOI":"10.1093\/rap\/rkab063","type":"journal-article","created":{"date-parts":[[2021,9,11]],"date-time":"2021-09-11T14:16:53Z","timestamp":1631369813000},"source":"Crossref","is-referenced-by-count":20,"title":["\u2018All disease begins in the gut\u2019\u2014the role of the intestinal microbiome in ankylosing spondylitis"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7769-6454","authenticated-orcid":false,"given":"Patricia","family":"Harkins","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eoghan","family":"Burke","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Swales","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Silman","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,9,11]]},"reference":[{"key":"2021092105414295200_rkab063-B1","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/imm.13242","article-title":"New developments in our understanding of ankylosing spondylitis pathogenesis","volume":"161","author":"Voruganti","year":"2020","journal-title":"Immunology"},{"key":"2021092105414295200_rkab063-B2","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1002\/acr.22831","article-title":"Global prevalence of spondyloarthritis: a systematic review and meta-regression analysis","volume":"68","author":"Stolwijk","year":"2016","journal-title":"Arthritis Care Res"},{"key":"2021092105414295200_rkab063-B3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00296-002-0237-4","article-title":"Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis","volume":"23","author":"Feldtkeller","year":"2003","journal-title":"Rheumatol Int"},{"key":"2021092105414295200_rkab063-B4","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1093\/rheumatology\/kei047","article-title":"The current concept of spondyloarthritis with special emphasis on undifferentiated spondyloarthritis","volume":"44","author":"Zochling","year":"2005","journal-title":"Rheumatology (Oxford)"},{"key":"2021092105414295200_rkab063-B5","doi-asserted-by":"crossref","first-page":"2369","DOI":"10.1056\/NEJMra1600266","article-title":"The human intestinal microbiome in health and disease","volume":"375","author":"Lynch","year":"2016","journal-title":"N Engl J Med"},{"key":"2021092105414295200_rkab063-B6","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/0016-5085(89)91557-6","article-title":"Ileocolonoscopy in seronegative spondylarthropathy","volume":"96","author":"De Vos","year":"1989","journal-title":"Gastroenterology"},{"key":"2021092105414295200_rkab063-B7","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1186\/s13075-016-1093-z","article-title":"Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis","volume":"18","author":"de Winter","year":"2016","journal-title":"Arthritis Care Ther"},{"key":"2021092105414295200_rkab063-B8","doi-asserted-by":"crossref","first-page":"3195","DOI":"10.1002\/art.30558","article-title":"Hypothesis: time for a gut check: HLA B27 predisposes to ankylosing spondylitis by altering the microbiome","volume":"63","author":"Rosenbaum","year":"2011","journal-title":"Arthritis Rheum"},{"key":"2021092105414295200_rkab063-B9","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1136\/ard.37.2.146","article-title":"Sequential studies in ankylosing spondylitis. 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