an introduction to a jungle of autoimmune diseases

1. Autoimmune rheumatic
diseases
And related conditions

2. Pick an organ, any organ . . .
Autoimmunity can affect ANY organ/organ system
in the human body
Autoimmune Uveitis Multiple Sclerosis
Psoriasis
Sjogren’s Syndrome
Pemphigus
Systemic Lupus Erythematosus
Rheumatic Fever
Diabetes
Autoimmune Hepatitis
Addison’s Disease
Autoimmune Oophoritis Ulcerative Colitis
Rheumatoid Arthritis
Autoimmune hemolytic Anemia

3. Autoimmunity Classification
Can be classified into clusters that are either
organ-specific or systemic

4. 4

5. Historical Perspective
The Virgin with Canon van
The Painter’s Family
Der Paele, 1436
Jacob Jordaens (1593-1678)
Jan van Eyck (1385-1440)
Evidence of:
Evidence of:
Rheumatoid Arthritis
Temporal (Giant Cell)
Arteritis

6. CDC: Census Bureau 2004

7. Multiple Factors Contribute to the
Development of Autoimmune diseases Nature Reviews Immunology, 2007

8. Multiple Cell Types and Cytokine Signaling Pathways Involved
in Chronic Inflammatory Arthritis
Modified from Choy, E. H.S. et al. N Engl J Med 2001;344:907-916
Key cytokines in Chronic
Naï ve T cell
Inflammatory Arthritis:
TNF-α
IL-1
IFN-γ
IL-6
OPGL (RANK-ligand)
IL-17

9. Rheumatoid Arthritis is Systemic
Inflammatory Disease

10. SLE is a Systemic Inflammatory Disease

11. Sjogren Syndrome

12. Therapeutic Strategies
Reagents that blunt inflammation but don’t have effects on disease progression:
Aspirin
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Non-selective and selective COX-2 antagonists
Steroids (prednisone)
Disease Modifying Anti-Rheumatic Drugs (DMARDs):
Broad Acting:
Methotrexate
Hydroxychloroquin
Azathoprine
Cyclophosphamide
Cyclosporin
More selective biologics:
TNF antagonists
IL-6R antagonists
IL-1R antagonists
anti-B cell (CD20) therapy
costimulatory inhibitors (CTLA4-Ig)
Intravenous Immunoglobulin (iv Ig)

13. Biological Therapeutics
Targets, Rationale, Status

14. Reumatologi Klinik Bandung 2013 14

15. Selamat menikmati workshop
Update on autoimmune diseases
Advances on the treatment for RA
Autoimmune diseases in opthalmology
The role of cyclosporine in psoriasis
Clinical experience in Cyclosporine + Mtx in the Th/ of RA
The role of cyclosporine in uveitis treatment