REDEFINING AUTOIMMUNE DISEASES: THE OPPORTUNITY FOR PRECISION AND PREVENTION.

In aggregate, autoimmune diseases affect at least 8% of the U.S. population, making them a significant health problem. Multiple lines of evidence accumulated over the last 20+ years have clearly demonstrated that the pathophysiology leading to autoimmune tissue damage and organ dysfunction occurs over a lengthy and clinically silent time period. As with other chronic diseases, this preclinical phase is an opportunity to identify people at risk and to develop medical and/or lifestyle interventions that can lessen the impact of disease or prevent it entirely. This will require movement away from historical disease definitions that emphasize the clinical features of tissue damage and toward more precise molecular definitions. It is a daunting task that requires large-scale epidemiological studies of immune dysfunction. Ultimately, it creates the opportunity to describe disease "stages" that give patients more clarity about their health and provide researchers, industry, and regulators with a path forward to autoimmune disease prevention.