Great stories always begin with “Once upon a time …”. The story of Lupus is no exception to this tradition! As a young intern in medicine, I was immediately fascinated by this bizarre disease with an enigmatic name. This fascination was conveyed to me by Maxime Seligman, the father of French clinical immunology, when I was allowed to work in his department at St. Louis Hospital in 1988. This passion for immunology and this fascination for lupus got him thanks to his curiosity and persistence and that rigor that is so important in the medical art.
Lupus was already a famous disease that has been the subject of much fetish research. The general public, but also most doctors, however, was unknown to the disease. How much progress has been made in so many areas since then! Knowledge of the disease, its management and its recognition in the medical world and the general public!
The understanding of lupus has “matured” considerably over the past 20 years. This disease still seems a bit complex, but today we have a pretty consistent picture of what could be causing and sustaining lupus. Everything is more consistent, but it is not (yet) possible to individually determine which specific mechanisms are involved. The combination of primal immunological and genetic data gives us, we discover, new “pieces” of this great puzzle that is lupus. Therefore, “part seekers” must also become “part inserts” in order to give all these advances an overall consistency.
The mystery of lupus is slowly growing because we now know triggers (ultraviolet, toxic) that are capable of innate immunity (i.e. there will be so many advances that I am sure that in a few years we will have the onset of the Predict disease or its epidemics and certainly better cope with them.
The management of the disease has improved a lot! Diagnosis is facilitated by a good knowledge of the clinical signs of the disease and, above all, by excellent biological tests that detect the “famous” autoantibodies (antinuclear antibodies) that are so characteristic of this disease. Today every laboratory can have these tests, which make the diagnosis of this disease much easier, provided, of course, that it is prescribed! In my early years as an “immunorheumatologist”, I still remember thinking of Françoise Danon’s subtle interpretations of antinuclear antibodies on layers of rat liver! And what heated discussions all these years about the interpretation of these tests with Joëlle Goetz, my “faithful accomplice” from Strasbourg in matters of autoimmunity! These diagnostic advances would not have been significant without the tremendous therapeutic advances. Twenty years ago, the everyday life of a “lupologist” was a subtle hesitation between corticosteroids, plaquenil, and possibly a strong immunosuppressant (azathioprine or cyclophosphamide).
Nevertheless, in the service of Maxime Seligman, we had been using the first anti-B-lymphocyte biomedicines since the early 1990s, which were therapeutic monoclonal antibodies of murine origin, very effective but so poorly tolerated! There have been great therapeutic advances since then, with studies to make better use of conventional drugs like cyclophosphamide, but also new drugs like mycophenolic acid and now the first biologics that block B lymphocytes or possibly other important molecules in lupus. About twenty molecules are currently being evaluated and we will see those in the years to come that can really change the lives of our patients. There is great hope, and one can even hope, that the concept of “personalized medicine” will be applied to lupus. It is therefore ideal to use “the right drug in the right dose at the right time in the right patient”, even if it does not cure the disease, this is a guarantee of efficiency and effectiveness. good compatibility.
Thanks to the fantastic work of everyone and especially the patient associations, lupus is now a well-known and recognized disease. Who would have thought 20 years ago that there would be a World Lupus Day? This recognition is of great importance to patients who need to know that their disease is known to doctors and recognized by the public and health authorities. This recognition made it possible to create information and education instruments such as “Lupus in 100 Questions” and to involve patients in valued therapeutic educational projects.
Thanks to everyone for the avoi