Over 5 million people, the population of a state like Norway: these are the patients who live with them in Europe chronic inflammatory diseases, pathologies united by a chronic inflammatory condition associated with an abnormal immune reaction directed against the body. Rheumatoid arthritis, chronic inflammatory bowel diseases – such as ulcerative colitis and Crohn’s disease – in addition to psoriasis and psoriatic arthritis, involve a daily management of painful or disabling symptoms, compromise the quality of life of patients, are a risk factor for development of comorbidities, such as cardiovascular diseases and tumors, and weigh on the life of families with important repercussions on the socio-economic side.
In recent years, attention to these diseases has grown, while research has made enormous progress in understanding the mechanisms underlying acute and chronic inflammation and has led to the development of therapeutic options capable of intervening on the inflammatory process.
To the growing impact of these diseases is devoted “Inflammations, challenges and responses – The people of chronic inflammatory diseases: biological factors, clinical aspects, social repercussions”, masterclass for journalists promoted by Galápagos Biopharma Italy together with the Irccs Humanitas Clinical Institute, a center of excellence for the research and treatment of inflammatory diseases. Focus of the event, the new perspective that focuses attention precisely on inflammation, the mechanism underlying these diseases, considering both the causes, including environmental ones, and the consequences on the whole organism, according to an integrated and multidisciplinary approach which favors continuity and interrelationships between the various chronic inflammatory diseases.
“Inflammation is a non-specific innate defense mechanism, which constitutes a protective response of the organism to the action of damage operated by a foreign agent to eliminate the initial cause of cell or tissue damage and start the reparative process – says Maria Rescigno, head of the mucosal and microbiota Immunology laboratory at Humanitas and Deputy Vice Rector with responsibility for Research at Humanitas University – inflammatory cells peculiar to innate immunity, such as macrophages, neutrophils, begin to produce cytokines in response to a stimulus that can be infectious, chemical, non-infectious. When acute inflammation does not resolve itself, chronic inflammation takes place which consists of a long-lasting inflammatory process in which active inflammation, tissue destruction and attempts at repair coexist ”.
Among the factors that determine inflammation – a note recalls – in recent years, attention has grown for the role played by the microbiota, the variegated set of microorganisms that live in symbiosis with us, in the intestine but also in all surfaces exposed to the external environment. A change in the intestinal microbiota can cause inflammation that from the intestine tends to spread to other organs as well. A recent study carried out by Humanitas and published in the journal ‘Science’ shows that in cases of ulcerative colitis, to prevent the spread of strong intestinal inflammation, the brain closes a sort of gate placed in the choroid plexus, with consequent states of anxiety-like and depression. Effects often found in patients with chronic inflammatory bowel disease.
There are over 250,000 people living with chronic intestinal inflammatory diseases in Italy – continues the note – of which about 60% with ulcerative colitis and the remaining 40% with Crohn’s disease. These diseases, which are on the increase in countries with advanced economies, are manifested above all by diarrhea, often accompanied by traces of blood, abdominal pain, vomiting, asthenia, fever, and are characterized by alternating periods of exacerbation and periods of remission. Up to 40% of patients with Crohn’s disease can undergo bowel resection within 10 years, and up to 20% of patients with ulcerative colitis can undergo colectomy within 10 years.
But the impact of these diseases goes beyond the intestinal district: “In over 40% of cases, chronic inflammatory bowel diseases are accompanied by associated immune-mediated extra intestinal manifestations – says Alessandro Armuzzi, head of the IBD operating unit for chronic intestinal inflammatory diseases of Humanitas, co-director of the Humanitas Ibd Center and professor of Humanitas University -. Up to 30% of patients may have arthritis, 10% immune-mediated skin manifestations, 5-6% inflammation of the biliary tract and liver. For this reason, a multidisciplinary approach cannot be ignored, which leads to better results in identifying any associated extraintestinal manifestations, but also in their management. The goal of therapy remains prolonged remission over time, which means the absence of symptoms, both those directly reported by the patient and in terms of the anatomy of the disease, that is the restoration of the normal integrity of the intestinal mucosa, without diarrhea and without bleeding “.
One of the increasingly considered tools for inducing remission is surgery, which is the best option for some patients with IBD. “Surgery is no longer considered the only option, the last resort, after having exhausted the available options, when the patient was completely defied by the symptoms of the disease and by the lack of response and immunosuppressed by medical therapies, with inevitable bad results. – underlines Antonino Spinelli, head of the Colon and Rectal Surgery Operating Unit of Humanitas, co-director of the Humanitas Ibd Center and professor of Humanitas University -. Today, thanks also to the multidisciplinary approach to chronic intestinal inflammatory diseases, which brings together the skills of gastroenterologists and surgeons, surgery, less and less invasive, is a weapon that can be used at any time of the therapeutic path, depending on the needs. of the individual patient “.
With two peaks of incidence located between 15-20 and 35-40 yearsIBDs affect people at the height of their social, working and family life, with a significant impact, both in terms of direct costs, related to the management of the disease, and in terms of indirect costs, such as productivity at work, pensions disability, sick days.
“Due to the type of impact that these pathologies have on the lives of the people affected by them, due to their peculiar symptoms, Mici are real” family diseases “: all members of the family are affected in some way by the discomfort caused by a chronic inflammatory bowel disease – adds Salvo Leone, general director of Amici Onlus and president of Efcca – European Federation of Crohn’s & Ulcerative Colitis Associations – but the impact also concerns the work environment: often the patient must be absent for visits and checks without the company and colleagues are aware of your condition. Help for patients with IBD has also come in recent years from digital technology, which makes it possible to bring the hospital closer to the patient’s home, reducing the frequency of visits, if not those strictly necessary, and thus also reducing absences from work and direct and indirect costs “.
Rheumatoid arthritis is characterized by its impact on the quality of life: deformity and joint pain if not adequately treated, can affect the patient’s ability to carry out normal daily activities and limit job opportunities, up to hindering the completion of household and family duties. However, the advent of new therapeutic options has changed a path that until a few years ago seemed inevitable.
“For patients diagnosed with rheumatoid arthritis today the good news is numerous – Carlo Francesco Selmi, head of the Operational Unit of Rheumatology and Clinical Immunology of Humanitas and Professor of Humanitas University, has no doubts – the most important element today is that the path of patients it does not lead to the deformities that can be seen on the net thanks to biological drugs e at small molecules that are able to stop inflammation and therefore the progression of the disease and they have brought down the curve of surgery to resolve these deformities. But there are also other positive notes: diagnoses are much earlier, thanks to greater knowledge and new diagnostic technologies; cortisone is used to a much lesser extent than in the past, avoiding medium and long-term side effects for patients; and patients of childbearing age can now plan a successful pregnancy, agreeing on the times and synchronizing the therapies so that they are not harmful to the fetus “.
Inflammatory mechanisms, together with triggers such as infections, stress and microbiota alterations, are at the origin of immune-mediated skin diseases such as psoriasis, which affects about 2 million people in Italy, and psoriatic arthritis. Psoriasis is a systemic disease in which the inflammatory process affects not only the skin, but also other areas and organs. Especially at a young age, this pathology is associated with an increased risk of acute cardiovascular events and in 20-30% of cases patients with psoriasis can develop psoriatic arthritis. Furthermore, in patients with psoriasis, especially in the moderate-severe form, it is possible to find subclinical intestinal inflammation, while 3% of patients with chronic inflammatory bowel diseases also have psoriasis.
“The link between intestinal inflammatory processes and those of the skin is demonstrated and it is therefore essential that patients with immune-mediated diseases are evaluated from multiple points of view and taken care of by a multidisciplinary team responsible for coordinating therapy and follow-up – recalls Antonio Costanzo, Head of the Dermatology Operating Unit of Humanitas and professor of Humanitas University – the professional medical figures who normally follow patients with psoriasis and psoriatic arthritis are the dermatologist and the rheumatologist but we also discuss with the gastroenterologist, to significantly improve the inflammation in the patient with Crohn’s disease and ulcerative colitis, thanks to combined therapies, which affect multiple areas by acting on a fundamental mechanism of pathogenetic inflammation “.
Studying chronic inflammatory diseases and making innovative therapeutic options available to patients is the heart of the commitment of Galápagos Biopharma Italy, a Belgian biotech company engaged in the research and development of innovative drugs that aim to respond to unmet medical needs. “As a pioneering company in the biotechnology sector, we have always dedicated ourselves to the search for innovative drugs with a simple purpose: to improve people’s lives and provide answers to unmet treatment needs – says Iole Cucinotto, medical director of Galápagos Italia – despite their enormous impact and spread, diseases such as Mici or rheumatoid arthritis have for a long time not found satisfactory treatment options, capable of truly freeing patients from the great limitations associated with their condition. For this reason we are dedicated to studying new mechanisms of action in inflammation and to identify innovative therapeutic targets, a premise for therapeutic options that we are making available and that can give concrete answers to the therapeutic needs of patients “.
#Europe #million #diagnosed #rheumatoid #arthritis #Mici