Autoimmunity: controversies in therapy and a new article collection in BMC Medicine

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Autoimmune diseases occur due to chronic stimulation of the immune system, leading the body to attack its own healthy tissues and organs. A wide variety of conditions, such as Type 1 diabetes, rheumatoid arthritis and celiac disease, are classified under this disorder. In addition, many diseases of unknown etiology are also believed to be of autoimmune origin, such as scleroderma and systemic lupus erythmatosous. However, the complex immunopathogenesis makes it difficult to effectively treat and manage many of the diseases. In some cases, there is controversy over the classification – for example at the CORA 2013 congress in Budapest last week, an hour-long debate moderated by Marco Matucci-Cerinic on the best way to treat scleroderma failed to reach a consensus- the main limitation being the elusive etiology of the disease. Additionally, some expressed their doubt over the autoimmune status of scleroderma and suggested that current treatment regimes that target the end stage, i.e. inflammation, may not be the best method of treatment.

In the late 90s, autoimmunity research was revolutionized by the successful introduction of biological compounds,namely the TNF-alpha inhibitors. However, much work is still needed to ensure that patients are diagnosed and treated early to prevent progression of the diseases. Yehuda Shoenfeld, a key researcher in the field of autoimmunity, emphasizes that the real focus should be on deciphering the origin of autoimmune diseases and the causal factors, rather than on how to treat the end stages. Based on discussions at multiple sessions at the CORA 2013 meeting, it seemed evident that there is a shift in focus towards epigenetics and personalized medicine, so keep an eye out for key developments in this field!

Another topic that elicited much debate at the congress was when and how to use biological compounds in the treatment of autoimmune disorders. Bearing Primum non nocere in mind, Ronald van Vollenhoven moderated a debate on the off-label use of biological therapy in pregnant patients who do not respond to other anti-inflammatory drugs , while Paul-Peter Tak passionately argued for the early start and stop of biological compounds in rheumatoid arthritis patients, as these have fewer side effects than the more commonly used methotrexate. One issue most agreed on was that the main limitation regarding biological therapy is the actual cost of the drugs, which limits access for many to this form of therapy.

In recognition of the ongoing controversies and research in this complex area of medicine, BMC Medicine has launched a new article collection, Cutting edge: issues in autoimmunity. In an editorial, guest editors Yehuda Shoenfeld and Nancy Agmon-Levin discuss the “mosaic of autoimmunity” and highlight some of the key findings and discussions of the 15 papers that so far have been included in the collection. The series comprises a review by Ziv Rosman et al. on biologic therapy in autoimmune diseases, and a review by Angela Tincani et al. on treatment options for Sjögren’s syndrome.

Ultimately, clinicians and patients have a common goal- fast diagnosis, and early treatment. This article collection of original research, review and commentaries sets out to answer some of the open questions in autoimmunity research. We will be adding further articles to the series throughout the year, so if you would like us to consider your work for inclusion please send a pre-submission query to bmcmedicineeditorial@biomedcentral.com.