Editorial

The Autoimmune Tautology: From Polyautoimmunity and Familial Autoimmunity to the Autoimmune Genes

Table 1

Shared characteristics among autoimmune diseases (ADs) supporting the autoimmune tautology*.

CharacteristicComment

Female predominanceThe more frequent the AD and the later it appears, the more women are affected.

Similar pathophysiologyDamage induced by T or B cells, or both, plays a major pathogenic role in ADs. Although the autoimmune phenotype varies depending on the target cell and the affected organ, the local mechanisms for tissue injury are similar.

Shared subphenotypesMathematical approaches for precisely defining subphenotypes based on accurate clinical and immunological databases, combined with strengthening molecular genetics analyses, have significant promise for a better understanding of ADs.

Age at onset influences severityEarly age at onset is a poor prognostic factor for some ADs.

Similar environmental factorsAlthough a latitudinal gradient of infectious agents exists, Epstein-Barr virus and cytomegalovirus are notorious as they are consistently associated with multiple ADs. Some infections could be protective against ADs development. Smoking has also been consistently associated with several ADs.

Ancestry influences clinical presentationAmerindian ancestry influences the risk of acquiring ADs as well as its severity.

Common genetic factorsThe genetic risk factors for ADs consist of two forms: those common to many ADs and those specific to a given disorder. Combinations of common and disease-specific alleles at HLA and non-HLA genes in interaction with epigenetic and environmental factors over time will determine the final phenotype.

PolyautoimmunityFactors significantly associated with polyautoimmunity are female gender and familial autoimmunity.

Familial autoimmunityUnlike familial AD, which corresponds to the presence of one specific AD in various members of a nuclear family, familial autoimmunity uses the term “autoimmune disease” as a trait that encompasses all accepted pathologies for which evidence suggests an autoimmune origin.

Similar treatmentSimilar biological and nonbiological therapies are used to treat diverse ADs.

*Adapted from references [28].