Prediction and prevention of autoimmune diseases: additional aspects of the mosaic of autoimmunity

Autoimmune connective tissue diseases are chronic, potentially life threatening complex multisystem disorders. Their etiology is unknown but genetic, hormonal and environmental factors are important. The clinical disease is preceded by a long period of time ( sometimes many years) when the patients can be identified by characteristic antibodies in their serum. When such a patient is identified he is usually followed and treated if clinical disease manifests itself. However, other factors besides the existence of autoantibodies have a predictive value for those disorders; some of them hereditary or genetic, and can be used only to predict likelihood of future disease, and others, connected to lifestyle and environment, could be modified in order to try and prevent it. Several non-randomized small scale studies have suggested that autoimmune disease could be prevented if treated aggressively prior to manifestations of symptoms. However, if such is the case, criteria would have to be formalized for selection of patients for this preventive treatment. Only patients whose probability to develop clinical disease is higher then a certain threshold should be treated while asymptomatic. The aim of this article is to review the major risk factors for autoimmune disease, both hereditary and environmental, and so to help define those future criteria. Individuals who are at risk to develop an autoimmune disease should be advised to refrain from activities and lifestyle which endangers their health and quality of life.