Immune-mediated inflammatory diseases ( IMIDs ) are a group of clinically diverse disorders arising from a dysregulated immune system and shared inflammatory pathways . More than 100 disorders have been identified that affect around 5 % of the global population and include immunodeficiencies , immunoproliferative disorders , autoimmune diseases and immune hypersensitivities . Inflammatory bowel disease ( IBD ), multiple sclerosis , type 1 diabetes , systemic lupus erythematosus , rheumatoid arthritis ( RA ), and psoriasis are among the most prevalent IMIDs . These diseases result from an intricate interplay between diverse factors including genetic susceptibility , infectious agents , diet , environmental factors and hormonal changes , among others . The incidence of IMIDs is increasing dramatically in many parts of the world , and environmental factors such as changes in the microbiome and psychosocial stress are among those thought to be responsible .
IMIDs can lead to organ damage and physical disability and place a significant burden on patients ’ lives . People with IMIDs have a reduced life expectancy and increased mortality compared with the general population . IMIDs are also associated with increased risk of comorbidities including cardiovascular disease and cancers , which contribute to further reduced quality of life and excess mortality . As well as significant patient burden , IMIDs are associated with increased healthcare utilisation and cause significant socioeconomic impact due to healthcare system burden and loss of work productivity .
Autoimmune rheumatic diseases are a heterogeneous group of conditions with overlapping clinical , laboratory and immunological manifestations . While the clinical presentations of many of these rheumatic diseases have been well-known for some time , the underlying causes are not fully understood . A spotlight article in this handbook focuses on the common rheumatological diseases – RA , ankylosing spondylitis ( AS ) and psoriatic arthritis ( PsA ) – summarising the hallmarks and clinical presentations of these disorders .
There are several immune-mediated dermatoses caused by direct damage of autoantibodies ( against skin antigens ) or by alterations of the immune system . The main characteristics – prevalence , pathogenesis , cutaneous manifestations , and associated comorbidities – of the most representative inflammatory dermatoses – psoriasis , atopic dermatitis , hidradenitis suppurativa , alopecia areata and vitiligo – are presented in this handbook , alongside the main autoimmune bullous and connective tissue diseases . The systemic inflammation frequently observed with inflammatory dermatoses is linked with an increased risk of atherosclerosis and cardiovascular acute events and impairment of patients ’ quality of life .
The most common gastrointestinal immune-mediated diseases are IBD – which includes Crohn ’ s disease and ulcerative colitis – and coeliac disease . These are the focus of a spotlight article in this handbook discussing their clinical presentation and disease course . The underlying causes are not fully understood and , consequently , these conditions are treatable but not curable at present . Current thinking suggests that the main autoimmune GI diseases involve an interplay between genetic predisposition , environmental factors and the gut microbiome , thereby resulting in inflammatory disease and gut malfunction .
The management of chronic disease presents a significant challenge for healthcare systems . While the primary focus may be on addressing acute issues and reducing waiting times , there is a growing demand for comprehensive care for chronic illnesses including autoimmune conditions . Autoimmune diseases are complex , unpredictable , and prone to relapse . This can lead to frustration , anxiety , depression and poor treatment adherence . Achieving treatment goals – which are designed to alleviate symptoms , prevent disease progression , and improve patients ’ quality of life – can be difficult if patients fail to comply with their treatment regimen . Lack of patient education and compliance with therapy leads to further hospital admissions and more complex treatment regimens . This , in turn , reduces adherence and a vicious cycle ensues .
It is essential to develop and implement patient education strategies that improve treatment adherence . Pharmacists can play a critical role in bridging the gap between patients and clinicians by providing patient education and alleviating any concerns about the treatment regimen . By delivering a patient-centred approach , pharmacists can support medication adherence and reinforce patient education , thereby improving the health outcomes of those in their care .
Current and future research will improve understanding of disease aetiology and identify new options for treatment and / or prevention of these debilitating conditions . For example , improved knowledge of the pathogenesis of inflammatory dermatoses has provided a recent treatment revolution .
In addition to the current resource , a second complementary handbook authored by thought leaders across Europe and the UK will focus on current management of these common , chronic immune-mediated conditions . Together these handbooks will provide an invaluable educational resource for all pharmacists , facilitating patient engagement and empowering patients to take control of their health and health care .
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