Autoantibodies - Future Trends

The impact of autoimmune diseases has grown exponentially both from a clinical and a diagnostic point of view in the last two decades. The knowledge of the pathogenic mechanisms underlying autoimmune diseases contributed to the identification of new autoantibodies and new diagnostic/prognostic assays have been developed. The most recent example is represented by the autoantibodies against citrullinated peptides that have been demonstrated to be useful in the diagnosis and the prognosis of rheumatoid arthritis and have been included in the new classification criteria. There is growing evidence that the characterization of the autoantibody profile rather than the detection of a single positivity can offer more information from a diagnostic point of view. Moreover, the autoantibody profile may identify the risk for developing specific organ involvement, thus becoming important also from a prognostic point of view. As a consequence, new diagnostic techniques have been developed with the aim of detecting multiple autoantibody specificities. The increasing number of the available methods and the spreading of autoimmunity testing make the problem of quality control (reproducibility, sensitivity, and specificity) and the clinical interpretation of particular concern. In addition, the use of new systems for autoantibodies raises the problem of their clinical significance in comparison with that of "historical" methods.