Autoimmune rheumatic Autoimmune rheumatic diseasesdiseases
And related conditions
Pick an organ, any organ . . .Autoimmunity can affect ANY organ/organ system in the human body
Pemphigus
Multiple Sclerosis
Sjogren’s Syndrome
Rheumatic Fever
Autoimmune Hepatitis
Ulcerative Colitis
Systemic Lupus Erythematosus
Diabetes
Autoimmune Uveitis
Autoimmune hemolytic Anemia
Addison’s Disease
Rheumatoid Arthritis
Autoimmune Oophoritis
Psoriasis
Autoimmunity Classification
Can be classified into clusters that are either organ-specific or systemic
4
The Painter’s FamilyJacob Jordaens (1593-1678)
Evidence of: Rheumatoid Arthritis
The Virgin with Canon vanDer Paele, 1436Jan van Eyck (1385-1440)
Evidence of:Temporal (Giant Cell) Arteritis
Historical Perspective
CDC: Census Bureau 2004
Multiple Factors Contribute to the Development of Autoimmune diseases Nature Reviews Immunology, 2007
Modified from Choy, E. H.S. et al. N Engl J Med 2001;344:907-916
Multiple Cell Types and Cytokine Signaling Pathways Involved in Chronic Inflammatory Arthritis
Key cytokines in ChronicInflammatory Arthritis:
TNF- IL-1
IFN-IL-6OPGL (RANK-ligand)IL-17
Naïve T cell
Rheumatoid Arthritis is Systemic Inflammatory Disease
SLE is a Systemic Inflammatory Disease
Sjogren Syndrome
Therapeutic Strategies
Reagents that blunt inflammation but don’t have effects on disease progression:AspirinNonsteroidal anti-inflammatory drugs (NSAIDs)
Non-selective and selective COX-2 antagonistsSteroids (prednisone)
Disease Modifying Anti-Rheumatic Drugs (DMARDs):Broad Acting:
MethotrexateHydroxychloroquinAzathoprineCyclophosphamideCyclosporin
More selective biologics:TNF antagonistsIL-6R antagonistsIL-1R antagonistsanti-B cell (CD20) therapycostimulatory inhibitors (CTLA4-Ig)Intravenous Immunoglobulin (iv Ig)
Biological TherapeuticsTargets, Rationale, Status
14Reumatologi Klinik Bandung 2013
Selamat menikmati workshopSelamat menikmati workshop
Update on autoimmune diseasesAdvances on the treatment for RA
Autoimmune diseases in opthalmologyThe role of cyclosporine in psoriasis
Clinical experience in Cyclosporine + Mtx in the Th/ of RAThe role of cyclosporine in uveitis treatment