Pediatric Rheumatology and Immunology Section, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
Clin Immunol. 2016 Apr;165:21-8. doi: 10.1016/j.clim.2016.03.002. Epub 2016 Mar 3.
Historically, autoimmune-inflammatory disorders were subdivided into autoinflammatory vs. autoimmune diseases. About a decade ago, an immunological continuum was proposed, placing "classical" autoinflammatory disorders, characterized by systemic inflammation in the absence of high-titer autoantibodies or autoreactive T lymphocytes, at the one end, and autoimmune disorders at the other end. We provide an overview of recent developments and observations, filling in some of the gaps and showing strong interconnections between innate and adaptive immune mechanisms, indicating that disorders from both ends of the immunological spectrum indeed share key pathomechanisms. We focus on three exemplary disorders: i) systemic juvenile idiopathic arthritis representing "classical" autoinflammatory disorders; ii) psoriasis, a mixed pattern disease; and iii) systemic lupus erythematosus, a prototypical autoimmune disease. We summarize scientific observations suggesting that, depending on disease stages and/or duration, individualized treatment targeting innate or adaptive immune mechanisms in disorders from either end of the immunological spectrum may control disease activity.
从历史上看，自身免疫性炎症性疾病被分为自身炎症性疾病和自身免疫性疾病。大约十年前，提出了一种免疫学连续统，将“经典”自身炎症性疾病（其特征为全身性炎症而不存在高滴度自身抗体或自身反应性 T 淋巴细胞）置于一端，将自身免疫性疾病置于另一端。我们提供了最近的发展和观察结果的概述，填补了一些空白，并显示先天和适应性免疫机制之间存在很强的相互联系，表明免疫谱两端的疾病确实具有共同的关键发病机制。我们重点介绍三种典型疾病：i）代表“经典”自身炎症性疾病的全身性幼年特发性关节炎；ii）银屑病，一种混合模式疾病；和 iii）系统性红斑狼疮，一种典型的自身免疫性疾病。我们总结了一些科学观察结果，这些结果表明，根据疾病阶段和/或持续时间，针对免疫谱两端的疾病中的先天或适应性免疫机制进行个体化治疗可能控制疾病活动。
