doi: 10.3389/fcell.2020.602574 202 TsilidisKKKasimisJCLopezDSNtzaniEEIoannidisJP
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It reflects a deeper immune imbalance involving the IL-17 and IL-23 inflammatory pathways, gut microbiome dysbiosis, genetic predisposition (HLA-B27 and related alleles), and environmental triggers including trauma, infection, and metabolic dysfunction
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