Академический Документы
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Autoimmune rheumatic
diseases: an introduction
About 1 in 20 individuals will develop an autoimmune condition during their lifetime, and autoimmune rheumatic diseases, which this volume of Medicine focuses on, are prominent
amongst them. The burden of these diseases both to the individual and to society cannot be underestimated. In economic
terms, for example, it is estimated that rheumatoid arthritis
costs the UK health system over 1 billion per annum due to
both the costs of looking after the patients per se and the loss of
productivity, as so many of them have been unable to continue
working.
David A Isenberg
Abstract
We are entering a very exciting time in human history as diseases of the immune system which have plagued mankind for
centuries are becoming much better understood and amenable to
more targeted therapies. Although not all autoimmune diseases
require immunosuppressive therapy (autoimmune hypothyroidism is a good example where replacement of the missing hormone, thyroxine, is a safe and effective treatment), a wide range
of conditions from chronic active hepatitis (which affects a single
organ or system) to systemic lupus erythematosus (which affects
virtually all organs or systems) are increasingly being treated by
monoclonal antibodies. This so-called biological therapy offers
the tantalizing prospect of effective treatment with far fewer side
effects. The classic immunosuppressive drugs, from corticosteroids to cyclophosphamide, were a major advance on what went
before (which was virtually nothing!) and have also contributed
significantly to both the morbidity and mortality of the autoimmune diseases. However, the capacity for biological agents to
induce serious side effects, as was observed recently at Northwick Park Hospital, cannot be ignored. It may be that the biological agent used in this case, which aimed to stimulate a T cell (via
the CD28 receptor), will prove highly exceptional but great care
will be needed with new approaches in the future.
Other diseases
The use of B cell depletion, employing rituximab either alone or
together with steroids and cyclophosphamide, has already been
shown to be of value, albeit in open label studies, in patients
with lupus, Wegeners granulomatosus, dermatomyositis and
Sjgrens syndrome. TNF- blockade using infliximab has shown
to be of benefit in patients with lupus and some forms of TNF-
blockade also help patients with Crohns disease. A variety of
agents are being tried in multiple sclerosis and it is possible to
say with confidence that within the next decade, certainly for
patients with more severe autoimmune diseases, major changes
in standard therapy are going to occur.
Clinical trials
MEDICINE 34:11
In the past few years it has clearly been established that the
prospective double blind placebo controlled clinical trial is an
essential tool in demonstrating the effectiveness of the biological
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Introduction
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Conclusion
This volume of Medicine will, I hope, demonstrate that not only
do we have a much better understanding of autoimmune diseases
in general, and autoimmune rheumatic diseases in particular, but
also that more targeted therapy using biological agents has really
arrived at the bedside having escaped from the laboratory!
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