The Amsterdam Rheumatology and Immunology Center ARC, Amsterdam, The Netherlands.
J Intern Med. 2018 Sep;284(3):228-239. doi: 10.1111/joim.12800. Epub 2018 Jul 2.
The autoimmune rheumatological diseases rheumatoid arthritis (RA), spondyloarthritis (SpA) and systemic lupus erythematosus (SLE) are treated with conventional immunosuppressive agents and with modern biological immunomodulators. The latter group of medications have brought about a major change in our ability to control RA and SpA, with more modest results for SLE. The biologicals are very specific in their mechanisms of action, targeting one specific cytokine or one particular cellular marker. Because of this, their efficacy can readily be linked to a single immunomodulatory mechanism. This observation has fuelled hopes that the efficacy of these agents can be predicted at the individual level based on the patient's genetic predisposition, immunological profile or disease phenotype. Whilst the biologic therapies have improved the prospects for patients with these diseases very significantly, the hope that they could be targeted to the patient in an individualized manner has not completely born fruit. In this review, I will argue that we are witnessing important progress in this field, and that justified hope exists for true advances in precision medicine in the autoimmune diseases in the coming years.
自身免疫性风湿病，如类风湿关节炎 (RA)、脊柱关节炎 (SpA) 和系统性红斑狼疮 (SLE)，采用传统免疫抑制剂和现代生物免疫调节剂进行治疗。后一组药物的出现极大地改变了我们控制 RA 和 SpA 的能力，而对 SLE 的效果则较为有限。生物制剂的作用机制非常特异，靶向一种特定的细胞因子或特定的细胞标志物。正因为如此，其疗效很容易与单一的免疫调节机制相关联。这种观察结果燃起了希望，即可以基于患者的遗传易感性、免疫特征或疾病表型，在个体水平上预测这些药物的疗效。尽管生物疗法极大地改善了这些疾病患者的预后，但希望能够以个体化的方式针对患者进行靶向治疗的愿望并未完全实现。在这篇综述中，我将认为我们正在见证这一领域的重要进展，并对未来几年自身免疫性疾病的精准医学取得真正的进展抱有合理的期望。
