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Book and Media Reviews
March 21, 2007

The Autoimmune Diseases

Author Affiliations

Book and Media Reviews Section Editor: John L. Zeller, MD, PhD, Fishbein Fellow, JAMA.

JAMA. 2007;297(11):1259-1263. doi:10.1001/jama.297.11.1261-a

Medicine has seen the dawn of a new era in the treatment of autoimmune diseases. Basic science has identified factors that mediate disease, translational projects have developed inhibitors, and clinical trials have proved efficacy. The list of approaches is growing, now including cytokine inhibitors, B-cell depletion, costimulatory blockers, and adhesion-molecule blockers.

The problem is that knowledge of how and when to use these agents remains rudimentary. Investigators and clinicians have experienced surprises when agents that we thought might work did not, or caused harm. We have also seen surprising efficacy where it might not have been expected. The result is the realization that we need better understanding of the diseases and the differences between individuals, at the least those with the same diagnosis. Biological intervention trials provide what are essentially controlled experiments in disrupting particular pathways in humans—not that different from what is done in animal models, although the access to tissues is obviously more limited. What we have not adequately done is learn all that we can from these experiments. In particular, specialists in one area (rheumatology, gastroenterology, endocrinology, neurology) often have limited awareness of mechanistic tests of biological interventions in other specialties. The need to share this information is essential.