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Looking at Disease in a New Way

Scientists think many autoimmune diseases act same way, respond to same drugs

FRIDAY, June 21, 2002 (HealthDayNews) -- It seems a strange place for a revolution: the Hilton San Francisco & Towers.

However, if members of the Federation of Clinical Immunology Societies (FOCIS) have their way at their annual meeting at the end of this month, clinical immunologists will become the internists of the future.

And, instead of treating asthma or psoriasis or Crohn's disease separately, they'll deal with a newly conceived group of diseases called Immune-Mediated Inflammatory Disorders, or IMIDs.

The category includes autoimmune diseases, as well as conditions such as transplant rejections and various skin and upper airway/respiratory disorders.

The idea of IMIDs has come into sharper focus over the last two years, as physicians have seen various, ostensibly separate, diseases respond to the same biological therapies.

"These are pharmaceuticals that don't just suppress the immune system, they target very specific parts of the immune system," says Dr. G. James Morgan, an associate professor of medicine at Dartmouth Medical School and a member of FOCIS.

For example, a biotherapeutic -- a drug to enhance the immune system -- that's designed to treat rheumatoid arthritis might also treat a patient's psoriasis and inflammatory bowel disease.

"The reason is that these diseases, even though they present with different organ-system involvement, share a common pathway of immune mediation," Morgan explains.

The same immune dysfunction results in chronic or acute inflammation which, depending on where it is located, can cause injury to various organs. The specific immune dysfunction is the activation of cytokines, proteins that are produced whenever the immune system perceives a threat to the body's well-being.

In a "normal" person, the cytokines will go away as soon as the threat subsides. Sometimes, though, the immune system overreacts, can't regulate itself, and that leads to autoimmune diseases, Morgan says.

To that end, FOCIS is bringing together 20 different medical centers to form a national academic platform that will start working toward more collaboration in the areas of diagnosis and treatment of disorders that upset the immune system. The idea is to look at disease in a new way.

"The hope is that we can better identify patients by pathogenesis instead of a certain name," Morgan says. "We're working together across subspecialties." The subspecialties include rheumatology, gastroenterology, oncology, dermatology and neurology, to name just a few.

In the future, these subspecialists may cease to think of themselves as "just" rheumatologists or dermatologists, as biotherapeutics emerge to treat more than one condition simultaneously.

Ultimately, physicians hope to eliminate the underlying causes of a disease, rather than just treating the symptoms with biotherapeutics, which inhibit the production of cytokines. These drugs are also more specific, targeting only one area of the immune system, rather than the whole system itself.

Also, Morgan says, "the earlier you can control the disease, the more likely you can stop it, rather than always chasing it."

What To Do

To find out more about FOCIS, click here. To learn more about autoimmune diseases, visit American Autoimmune Related Diseases Association, or the National Institutes of Health.

SOURCES: G. James Morgan, M.D., associate professor, medicine, Dartmouth Medical School, Hanover, N.H.
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