2023-09-27 00:16:28
Who hasn’t had back pain at some point? There are some diseases that, apart from being rare in the family doctor’s office, present with common and mild symptoms that further complicate the diagnosis, for example, ankylosing spondylitis. It can take between five and nine years until the specialist gives a name to your condition and the same is true for many of what are considered immune-mediated inflammatory diseases (IMID).
A recent study indicated that patients with hidradenitis suppurativa take an average of 10.5 years to become aware of their condition. For this reason, experts in this type of pathology demand greater attention, not only to treatments, but to early detection. This was indicated at the discussion table on immune-mediated diseases recently organized by EL MUNDO, with the sponsorship of AbbVie and AstraZeneca.
Psoriasis, rheumatoid arthritis, ulcerative colitis, sarcoidosis, Crohn’s disease, lupus… IMIDs constitute a very heterogeneous set of chronic and disabling diseases. that affect “around 12% of the Spanish population,” said Carlos González Fernández, a rheumatologist at the Gregorio Marañón University Hospital in Madrid. Each one has its own path, in terms of its own peculiarities, symptoms, prognosis and treatments. However, they all share the imbalance of inflammatory cytokines, they all have a genetic component and in all of them, the environmental factor plays a primary role.
As a consequence of all this, it is not strange that several of these diseases occur in the same patient. Specifically, it has been seen that almost 10% are diagnosed with two or more immune-mediated diseases. In the case of ankylosing spondylitis, it is estimated that between 5% and 10% of those affected will end up developing an inflammatory bowel disease, either ulcerative colitis or Crohn’s disease.
«Up to 25% of people with psoriasis develop psoriatic arthritis», emphasized González Fernández. Hence, multidisciplinary work is a key piece in the management of these diseases. Unfortunately, not all hospitals have a comprehensive care unit. “What we do is ask colleagues from different specialties for help, for the benefit of the patient,” said Paco Mesonero, gastroenterologist at the Ramón y Cajal University Hospital in Madrid.
Along the same lines, rheumatologist Ana Pérez, from the Príncipe de Asturias University Hospital in Alcalá de Henares (Madrid), stated: «Knowledge in all areas is so extensive that one cannot cover everything. […] Multidisciplinary collaboration is basic.
Multidisciplinary care
In some centers, such as the Infanta Leonor University Hospital, “we have a rheumatology and dermatology consultation model” that works very well in patients with psoriasis and rheumatoid arthritis, argued dermatologist Pablo de la Cueva. However, attempts are being made to design larger circuits. For example, for hidradenitis suppurativa, since “the entry point for affected patients is usually the emergency room, due to serious and acute symptoms of their disease.” Also “it would be appropriate with plastic and general surgery and digestive surgery,” because sometimes there is an associated inflammatory bowel disease.
Furthermore, it is known that patients with psoriasis and hidradenitis suppurativa have a higher risk of cardiovascular disease, metabolic syndrome, hypertension, diabetes, obesity…
In this sense, the reference example is found in the Gregorio Marañón University Hospital. “We have so many chronic patients who share similar comorbidities: obesity, hypertension, liver disease… And also, the stigma and psychological trauma of having a chronic disease,” lamented González Fernández. And he added: «“We have to offer them a service that helps them comprehensively.” This is the Center for Immune-Mediated Inflammatory Diseases (CEIMI). «We have dermatology, rheumatology, digestive, ophthalmology, psychiatry, psychology, preventive nutrition… We have been there for four years and the results, both in the quality perceived by the patient and in remission rates for each of the diseases, are really good» . The specialists agreed that this is the model to follow, although it is “very complex to do and depends on hospital management,” acknowledged the rheumatologist.
These comprehensive units would provide part of the solution to early diagnoses, but not 100%. For this, in the words of González Fernández, “training is needed for primary care doctors” and, of course, “more professionals in family consultations.” As De la Cueva illustrated, just as psoriasis is “relatively easy” to diagnose, diseases that affect special locations are not so easy.” For example, “genital psoriasis, which is sometimes confused with fungus or dermatitis.” Sometimes it also happens that “cases of Crohn’s disease are labeled as irritable bowel syndrome,” as Mesonero pointed out.
Aside from training, another key element that complicates early diagnosis is the intensity of symptoms. When they are painful or alarming, the gastroenterologist said, “fortunately, the patient gains a diagnosis sooner,” but when the symptoms are mild, the process slows down. It happens with “Crohn’s disease, when the symptoms are not very relevant, the delay in diagnosis is between three and five years.”
Biological treatments
Early diagnosis and treatments are the cornerstones to change the course of any disease. In this field, considerable progress has been made. As González Fernández recalled, at the end of the 90s rheumatology consultations were full of wheelchairs and canes. “Now, we have patients with chronic arthritis who live their normal lives, work and retire without any problems,” thanks to “biological drugs, which have completely changed the landscape» . There are also increasingly effective treatments for psoriasis. The therapeutic arsenal has helped a lot in Crohn’s disease. In others, however, there is still much to do, such as hidradenitis suppurativa or scleroderma.
What is clear is that we must continue investigating. In fact, there are several very promising open lines that, little by little, should clear the way.
#Experts #call #joint #approach #immunemediated #diseases