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