LABORATORY DIAGNOSIS AND MONITORING IN CHRONIC SYSTEMIC AUTOIMMUNE-DISEASES

The testing done in the diagnostic immunology laboratory contributes t o the management of patients with systemic autoimmune diseases. In the se diseases the interaction between environmental factors and a geneti cally dysregulated immune system produces a continually variable level of disease activity. Improved techniques now allow the clinical scien tist to assess the integrity of a patient's immune system and to ascer tain qualitative or quantitative disturbances in its activation and ex pression. Cellular and humoral immunity may become independently activ ated or dysfunctional in certain disease processes, although the gener ation of amplifying proteins may result in the full clinical expressio n of immunity and autoimmune inflammation. Autoimmune diseases can, in part, be characterized according to the activation pattern of gene ex pression encoding the amplifying and proinflammatory cytokines. Modern therapy is increasingly aimed at determining ways to influence discre te elements of the immune apparatus; therefore, it is important to ide ntify and characterize the patterns of expression of the immune system mediators serially in chronic autoimmune disease states. Newer diagno stic procedures stemming from observations in basic and clinical resea rch are expanding the useful database on patients, but they must be ca refully evaluated to prove their applicability and efficacy. Because b lood samples are the best available specimens for testing, one must co nsider all the possible sampling problems and pitfalls of using result s from peripheral blood to judge changes in function of the lymphoid s ystem.