Classical Examples of the Concept of the ASIA Syndrome.

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) was first introduced in 2011 by Shoenfeld et al. and encompasses a cluster of related immune mediated diseases, which develop among genetically prone individuals as a result of adjuvant agent exposure. Since the recognition of ASIA syndrome, more than 4400 documented cases have been reported so far, illustrated by heterogeneous clinical manifestations and severity. In this review, five enigmatic conditions, including sarcoidosis, Sjögren's syndrome, undifferentiated connective tissue disease, silicone implant incompatibility syndrome (SIIS), and immune-related adverse events (irAEs), are defined as classical examples of ASIA. Certainly, these disorders have been described after an adjuvant stimulus (silicone implantation, drugs, infections, metals, vaccines, etc.) among genetically predisposed individuals (mainly the HLA-DRB1 and PTPN22 gene), which induce an hyperstimulation of the immune system resulting in the production of autoantibodies, eventually leading to the development of autoimmune diseases. Circulating autonomic autoantibodies in the sera of patients with silicone breast implants, as well as anatomopathological aspects of small fiber neuropathy in their skin biopsies have been recently described. To our knowledge, these novel insights serve as a common explanation to the non-specific clinical manifestations reported in patients with ASIA, leading to the redefinition of the ASIA syndrome diagnostic criteria.

Resultados de los tratamientos biológicos en las enfermedades autoinmunitarias / Results of biological treatments in autoimmune diseases

El uso de los tratamientos biológicos ha revolucionado en los últimos años el manejo de numerosos procesos autoinmunitarios. Ello ha llevado a numerosos investigadores y clínicos a intentar aplicar estas terapias en otras enfermedades (lupus, síndrome de Sjögren, vasculitis, etc.). Desde la introducción de los corticoides e inmunosupresores, las vasculitis pasaron de ser enfermedades mortales a tener tasas de remisión elevadas. Sin embargo, son tardías, no son permanentes y requieren el uso mantenido de fármacos. En este contexto, los nuevos fármacos biológicos han de superar el reto de inducir una remisión temprana y permanente que minimice el daño orgánico irreversible, reducir (o eliminar) la exposición a esteroides e inmunosupresores y mejorar la función del paciente. En este capítulo se revisan los datos que existen actualmente en la literatura respecto a la utilidad de los fármacos biológicos en las vasculitis sistémicas (AU)

The use of the biological therapies has revolutionized in the last years the handling of numerous autoimmune processes. It has taken to numerous physicians and investigators to try to apply these therapies in other diseases (lupus, Sjögren, vasculitis, etc). From the introduction of corticosteroids and immunosupressives, vasculitis were no more a mortal diseases, and it was possible to obtain high rates of remission. Nevertheless, they are delayed, they are not sustained, and require of the use of maintained drugs. Against this background, the new biological drugs have to surpass the challenge to induce an earlier and permanent remission that diminishes irreversible organ damage, to reduce (or to eliminate) the exposition to steroids and immunesupressives and to improve the patient function. This article reviews data present until now in literature with respect to the utility of biological drugs in systemic vasculitis (AU)