Units of systemic autoimmune diseases

Notes of an ongoing experiment

Abstract

Systemic autoimmune diseases (EAS) are specific non-organ autoimmune pathologies whose pathogenesis is focused on the loss of self-tolerance, clinically characterized by the involvement of multiple organs or tissues in an additive, successive or simultaneous way, requiring an approach for diagnosis and treatment. multi-disciplinary. The denomination of EAS tends to replace the term collagenopathies (connective diseases or mesenchymopathies), highlighting with this new designation its profile of organic injury beyond collagen-joint damage, extending its damaging capacity as a systemic entity, as its denomination indicates. A non-exhaustive list of entities that are included in the EAS includes: systemic lupus erythematosus, antiphospholipid syndrome, Sjögren's syndrome, systemic sclerosis (scleroderma), dermatomyositis, inflammatory myopathies, overlapping syndromes, mixed connective tissue disease, undifferentiated disease of connective tissue and primary systemic vasculitis, within the most frequent pathologies. The permanent growth of disciplines such as immunology and molecular biology had direct repercussions on the significant growth of basic-clinical knowledge of EAS, managing to dissect molecular mechanisms responsible for these pathologies, enabling the development of new biological therapies. At the end of the 1980s, at the clinical level this generated that different groups within internal medicine began to focus their work on EAS, concentrating experience and renewing diagnostic and treatment strategies. Looking for the pioneering groups in this clinical redirection we find in Barcelona the Clìnic Hospital team, then directed by Dr. Joseph Font, and currently directed by Dr. Ricard Cervera. In Paris we find two groups, one led by Dr. Jean-Charles Piette, and another by Dr. Loic Guillevin. In London, the Lupus Research Unit, led by Graham Hughes, was led by Dr. Munther Khamashta. Some time later, other groups joined, such as the Cruces University Hospital, Barakaldo, Spain, led by Dr. Guillermo Ruiz Irastorza, and the foundation of the Zabludowicz Center, led by Dr. Yehuda Shoenfeld, emerged more recently in Israel. This change (of minor magnitude) in the United States took place in 2003 with the creation of the Centers of Excellence in Autoimmunes. Latin America did not remain free of these influences, adopting some centers similar work modalities.