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Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder. One major histocompatibility complex gene, HLA-B27, is the strongest known risk factor associated with AS. Some of the unique features of HLA-B27 have led to different hypotheses to explain the mechanisms underlying the association between HLA-B27 and AS pathogenesis. Additionally, other MHC factors, non-MHC factors and environmental factors have also been implicated in AS susceptibility. This review highlights the different HLA -B27 hypotheses, as well as the roles of some of the other factors in determining AS susceptibility. It is evident that, individually, none of these factors can take complete credit for causing AS since it is a multi-factorial autoimmune disease.

Ankylosing Spondylitis: A Multi-Factorial Autoimmune Disease. MHC Class I, Antigen Presentation and others to Blame