Glucolipid metabolic dysfunction in ankylosing spondylitis: inflammatory mechanisms, immune-metabolic crosstalk and therapeutic implications of natural products and traditional Chinese medicine.

Ankylosing spondylitis (AS) is increasingly recognized as a systemic inflammatory disease accompanied by substantial glucolipid metabolic disturbances and an elevated risk of diabetes. Beyond articular inflammation, persistent immune activation reshapes metabolic homeostasis through interconnected mechanisms involving chronic cytokine signaling, immune-cell metabolic reprogramming, gut microbiota dysbiosis and endocrine disruption. Key mediators, including TNF-α, IL-6 and IL-17, promote insulin resistance, lipid abnormalities and endothelial dysfunction, while Th17/Treg imbalance, neutrophil activation and microbial metabolite alterations further amplify metabolic injury. These pathogenic interactions establish a self-reinforcing cycle in which inflammation and metabolic dysfunction mutually exacerbate one another. Emerging evidence also indicates that anti-inflammatory therapies, nutritional strategies and metabolic modulators may provide dual benefits by controlling disease activity while improving metabolic outcomes. This review summarizes the mechanistic links between AS and glucolipid dysregulation and highlights integrated therapeutic strategies, including pharmacological interventions, nutritional approaches, and natural products/traditional Chinese medicine, for reducing diabetes risk and improving long-term prognosis in AS.