脊柱关节炎是一组免疫介导的风湿性疾病，严重影响患者的身体功能和生活质量。罹患脊柱关节炎的患者更容易发生心脏代谢性疾病，如肥胖、高血压、血脂异常和糖尿病，这些合并症与脊柱关节炎活动性的增加和心血管事件的风险有关。本综述总结了脊柱关节炎炎症状态与心脏代谢性合并症之间的生理联系的证据，以及与对心脏代谢条件的患者中白细胞介素（IL）-17阻断与其他分子机制之间的影响。IL-23/IL-17轴在脊柱关节炎的病理生理过程中起到关键作用，通过促进受累关节和附着点的炎症和组织重塑。IL-23/IL-17信号通路在常见心脏代谢性疾病潜在亚临床炎症中的重要性，表明这些过程与脊柱关节炎病理生理过程之间存在共享途径。因此，在治疗决策过程中必须考虑生物治疗的作用对患者的心脏代谢特征的影响。生物治疗可能会引起患者心脏代谢状态的变化，而心脏代谢条件反过来可能影响对生物治疗的临床反应。关于secukinumab对心脏代谢参数的影响的现有证据表明，该药物不会干扰传统的心血管风险标记物，并且可能与减少心血管事件的风险相关。此外，secukinumab的疗效和持续使用率似乎不会受到肥胖的负面影响，一些研究报告显示其对临床结果产生积极影响，与其他方法（如肿瘤坏死因子阻断）的描述相反。在本文中，我们还综述了脊柱关节炎其他治疗方法中存在的双向联系的证据。当前证据表明，带有心脏代谢性合并症的脊柱关节炎患者在应用secukinumab的IL-17靶向治疗方案时效果显著，并可能带来额外的心脏代谢益处。版权 © 2023 Queiro，Aurrecoechea，Alonso Castro，Villa Blanco，Brandy-Garcia和Linge。

Spondyloarthritis is a group of immune-mediated rheumatic disorders that significantly impact patients' physical function and quality of life. Patients with spondyloarthritis experience a greater prevalence of cardiometabolic disorders, such as obesity, hypertension, dyslipidemia and diabetes mellitus, and these comorbidities are associated with increased spondyloarthritis disease activity and risk of cardiovascular events. This narrative review summarizes the evidence for a physiological link between inflammatory status and cardiometabolic comorbidities in spondyloarthritis, as well as the impact of interleukin (IL)-17 blockade versus other molecular mechanisms in patients with cardiometabolic conditions. The IL-23/IL-17 axis plays a pivotal role in the pathophysiology of spondyloarthritis by promoting inflammation and tissue remodeling at the affected joints and entheses. The importance of the IL-23/IL-17 signaling cascade in underlying sub-clinical inflammation in common cardiometabolic disorders suggests the existence of shared pathways between these processes and spondyloarthritis pathophysiology. Thus, a bidirectional relationship exists between the effects of biologic drugs and patients' cardiometabolic profile, which must be considered during treatment decision making. Biologic therapy may induce changes in patients' cardiometabolic status and cardiometabolic conditions may conversely impact the clinical response to biologic therapy. Available evidence regarding the impact of IL-17 blockade with secukinumab on cardiometabolic parameters suggests this drug does not interfere with traditional cardiovascular risk markers and could be associated with a decreased risk of cardiovascular events. Additionally, the efficacy and retention rates of secukinumab do not appear to be negatively affected by obesity, with some studies reporting a positive impact on clinical outcomes, contrary to that described with other approaches, such as tumor necrosis factor blockade. In this article, we also review evidence for this bidirectional association with other treatments for spondyloarthritis. Current evidence suggests that IL-17-targeted therapy with secukinumab is highly effective in spondyloarthritis patients with cardiometabolic comorbidities and may provide additional cardiometabolic benefits.Copyright © 2023 Queiro, Aurrecoechea, Alonso Castro, Villa Blanco, Brandy-Garcia and Linge.