Chronic autoimmune rheumatic diseases: a challenge for the health system

 

Pier Luigi Meroni

IRCCS Istituto Auxologico Italiano

 

Chronic autoimmune rheumatic diseases are a heterogeneous group of disorders including inflammatory arthritis (e.g. rheumatoid arthritis, spondylopathies, psoriatic arthritis, juvenile idiopathic arthritis) and the so-called connective tissue diseases such as systemic lupus erythematosus, lupus-like disorders, Sjogren syndrome, scleroderma. As a whole these disorders are affecting 2-3% of the general population, are characterized by chronicity, relapsing/remitting clinical presentation and the need for prolonged treatments. The economic and social impact is huge due to the high direct and indirect costs for their management and the fact that they are mainly affecting people between the 2nd and the fifth decade of age. There is a large variability of the disease presentation, which is apparently related to different variables such as the presence of several clinical and biological disease subtypes, the influence of geographic and ethnic differences. Such heterogeneity is apparently responsible for the variability of the response to the available treatments, including the new biological and synthetic drugs. Clinical trials are mandatory for evaluating the efficacy/safety of the new therapies, but the results are frequently far from the clinical real life because of the heterogeneity of the patients linked to ethnic and geo-political differences. A great effort is needed for improving the classification/inclusion criteria for chronic autoimmune rheumatic diseases and their personalized management. The Big Data approach is emerging as an innovative strategy for fulfilling these needs.