If Lupus was told to me

If Lupus was told to me

The beautiful stories always begin with "Once upon a time...". The history of Lupus does not derogate from this tradition! When I was young intern in medicine, I was immediately fascinated by this so bizarre disease with the enigmatic name. This fascination was transmitted to me by Maxime Seligman, father of the French clinical immunology when I had the chance to work in his service at the St Louis Hospital in 1988. This passion for immunology and this fascination for the Lupus had allowed him thanks to his curiosity and his perseverance and this rigor so important in the medical art.

Lupus was already a famous disease, the subject of many fetish researches. On the other hand, the disease was unknown to the general public, but also to most doctors. What progress has been made since then in so many areas! The knowledge of the disease, its care and its recognition in the medical world and the general public!

The understanding of lupus has been considerably "sophisticated" for 20 years. This disease still seems a little complex, but today we have a fairly consistent picture of what could cause and maintain lupus. Everything is more coherent, but it is not (yet) possible to determine individually what specific mechanisms are involved. The combination of original immunological and genetic data gives us, at the discretion of the discoveries, new "pieces" of this great puzzle that is lupus. Thus, "coin searchers" must also become "coin depositors" in order to give overall coherence to all these advances.

The mystery of lupus rises slowly because we know now triggering factors (ultraviolet, toxic) capable of stimulating innate immunity (ie our archaic immunity) to make it produce interferon that participates in the amplification and runaway of the immune response. there will be so much progress that I am sure that within a few years we may be able to predict the onset of the disease or its outbreaks and certainly better manage it. 

The management of the disease has progressed considerably! The diagnosis is facilitated by a good knowledge of the clinical signs of the disease and especially thanks to excellent biological tests that detect the "famous" autoantibodies (antinuclear antibodies) that are so characteristic of this disease. Today, any laboratory can have these tests that greatly facilitate the diagnosis of this disease provided of course to prescribe! Thus, in my first years as an "immunorheumatologist", I still remember thinking about subtle interpretations of antinuclear antibodies on layers of rat liver prepared by Françoise Danon! And what heated discussions all these years for the interpretation of these tests with Joëlle Goetz, my "faithful accomplice" Strasbourg auto-immunity! These diagnostic advances would not have been important without the tremendous therapeutic advances. Twenty years ago, the daily life of a "lupologue" was a subtle hesitation between corticosteroids, Plaquenil and possibly a powerful immunosuppressant (Azathioprine or Cyclophosphamide).

Nevertheless, in the service of Maxime Seligman, since the early 1990s, we had already used the first anti-B lymphocyte biomedicines that were therapeutic monoclonal antibodies of murine origin, very effective, but so poorly tolerated! Since then there has been major therapeutic progress, with studies to better use conventional drugs such as Cyclophosphamide, but also new drugs such as mycophenolic acid and now the first biomedicines to block lymphocyte B or possibly other important molecules in lupus. Twenty molecules are being evaluated and we will see in the coming years those that can really change the lives of our patients. The hope is great and we can even hope to apply the concept of "personalized medicine" in lupus. Thus, the ideal will be to use "the right medicine, at the right dose, at the right time in the right patient" even if it does not cure the disease, it will be a guarantee of efficiency and effectiveness. good tolerance.

Thanks to the fantastic work of everyone and first of all the patient associations, lupus is today a known and recognized disease. Who could have imagined 20 years ago that there would be a world lupus day? This recognition is of major importance for patients who need to know that their disease is known to the medical profession and recognized by the general public and health authorities. This recognition has helped to create information and educational tools such as "Lupus in 100 questions", and to involve patients in therapeutic education projects so appreciated.

Thank you all for helping to "get the wolf out of the shadows" and "fly the butterfly in the light"! You will recognize the symbols of this disease that remains for us the subject of so many discussions, projects and exciting work. I hope, in 20 years, may be able to write the rest of this story with the inspiration of Alexandre Dumas, in all humility, of course (20 years later)!

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