From the Guidelines
Immune-mediated inflammatory diseases (IMIDs) are a group of disorders characterized by abnormal immune system activity that causes inflammation and tissue damage in various parts of the body, including conditions such as rheumatoid arthritis, psoriasis, and inflammatory bowel diseases. These conditions occur when the immune system mistakenly attacks healthy cells and tissues instead of protecting the body from harmful pathogens 1. IMIDs typically involve complex interactions between genetic predisposition and environmental triggers that lead to dysregulation of immune responses.
Key Characteristics of IMIDs
- They include a range of conditions such as rheumatoid arthritis, psoriasis, inflammatory bowel diseases (like Crohn's disease and ulcerative colitis), multiple sclerosis, type 1 diabetes, and systemic lupus erythematosus, among others
- Treatment generally focuses on controlling inflammation and modulating immune system activity through medications such as corticosteroids, immunosuppressants, disease-modifying antirheumatic drugs (DMARDs), and biologic therapies that target specific inflammatory pathways 2
- These conditions are often chronic and require long-term management strategies that balance controlling disease activity while minimizing medication side effects ### Importance of Early Diagnosis and Treatment Early diagnosis and treatment are crucial to prevent progressive tissue damage and maintain quality of life for affected individuals. The therapeutic options for patients with IMIDs have significantly improved over the past two decades, primarily due to the introduction of novel medications, including biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi) 1.
Current Treatment Approaches
Current treatment approaches include the use of biologic drugs, which can be adjusted reactively or proactively through therapeutic drug monitoring (TDM) to achieve target serum drug levels and optimize treatment outcomes 2. However, the role of proactive TDM in clinical practice remains unclear, with conflicting guideline recommendations and emerging evidence from randomized controlled trials.
From the FDA Drug Label
Immune disorders: macrophage activation syndrome, systemic vasculitis, sarcoidosis Musculoskeletal and connective tissue disorders: lupus-like syndrome Skin and subcutaneous tissue disorders: cutaneous lupus erythematosus, cutaneous vasculitis (including leukocytoclastic vasculitis), erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis
Immune-mediated, inflammatory diseases include conditions such as:
- Lupus-like syndrome
- Macrophage activation syndrome
- Systemic vasculitis
- Sarcoidosis
- Cutaneous lupus erythematosus
- Cutaneous vasculitis These are autoimmune disorders that can occur in patients treated with certain medications, such as etanercept 3.
From the Research
Definition and Overview of Immune-Mediated Inflammatory Diseases
- Immune-mediated inflammatory diseases (IMIDs) are a group of common and highly disabling chronic conditions that share inflammatory pathways 4.
- These diseases are characterized by excessive immune responses involving T cells and their subsets, leading to direct tissue damage 5.
- IMIDs include a range of conditions such as rheumatoid arthritis, Crohn's disease, psoriasis, and psoriatic arthritis, among others 6.
Therapeutic Advances and Treatment Options
- The therapeutic armamentarium for IMIDs has been transformed in the past two decades, with a shift from broad-spectrum immune modulators to agents with exquisite specificity 7.
- Targeted biologic therapies have revolutionized the treatment of IMIDs, offering efficacy, speed of onset, and tolerability 6.
- Novel therapies, including biologic agents, Janus kinase (JAK) inhibitors, and mesenchymal stem cells, are being explored for the treatment of IMIDs 8, 5.
Epidemiology and Prevalence
- The estimated prevalence of IMIDs in Western society is 5%-7% 4.
- Incidence and prevalence studies of IMIDs have reported a considerable variation of the disease occurrence among different populations 4.
Pathobiology and Immunopathological Basis
- IMIDs share similar immune dysregulation, with T cells and their subsets playing a key role in the disease process 6, 5.
- Recent studies have shown that mesenchymal stem cells can suppress T cells through direct cell-to-cell contact or secretion of soluble cytokines, offering insights into the underlying immunopathological basis of IMIDs 5.