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Autoimmun Rev. 2017 Sep;16(9):911-924. doi: 10.1016/j.autrev.2017.07.012. Epub 2017 Jul 11.

International consensus: What else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)?: The unmet needs and the clinical grey zone in autoimmune disease management.

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Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy. Electronic address:
Clinical Medicine and Rheumatology Department, Campus Bio-Medico University of Rome, Rome, Italy.
Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
Rheumatology Unit, University of Pisa, Via Roma, Pisa, Italy.
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy.
Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy.
Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain.
Rheumatology Unit, Department of Internal Medicine, University of Palermo, Palermo, Italy.
Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria 'S. Maria della Misericordia', Udine, Italy.
Division of Rheumatology, department of Medicine, University of Padova, Padova, Italy.
Rheumatology Clinic, Department of Internal Medicine Medical School, University of Ioannina, Ioannina, Greece.
Division of Rheumatology, ASST.G Pini, Department of Clinical Sciences and Community Health, University of Milan and Istituto Auxologico Italiano, Milan, Italy.
Departement of health sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.
Laboratory of Tissue Homeostasis and Disease, Department of Development and Regeneration, KU Leuven and Division of Rheumatology, Skeletal Biology and Engineering Research Center, University Hospitals Leuven, Leuven, Belgium.
Rheumatology Unit, Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
Department of Medicine, University of Verona, Verona, Italy.
Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy.
Immunology and Pathology, Brest University, SFR ScinBios, Labex 'Immunotherapy, Graft, Oncology', Brest, France.
Department of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova, Genova, Italy.
Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
Rheumatology Unit, ASST-Fatebenefratelli-L, Sacco University Hospital, Milan, Italy.
The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 5265601 Tel-Hashomer, Israel.
Sections of Rheumatology, Instituto San Giuseppe, Como and Casa di Cura di Lecco, Lecco, Italy.
Department of Pathophysiology, University of Athens, Athens, Greece.


Autoimmune diseases are a complex set of diseases characterized by immune system activation and, although many progresses have been done in the last 15years, several unmet needs in the management of these patients may be still identified. Recently, a panel of international Experts, divided in different working groups according to their clinical and scientific expertise, were asked to identify, debate and formulate a list of key unmet needs within the field of rheumatology, serving as a roadmap for research as well as support for clinicians. After a systematic review of the literature, the results and the discussions from each working group were summarised in different statements. Due to the differences among the diseases and their heterogeneity, a large number of statements was produced and voted by the Experts to reach a consensus in a plenary session. At all the steps of this process, including the initial discussions by the steering committee, the identification of the unmet needs, the expansion of the working group and finally the development of statements, a large agreement was attained. This work confirmed that several unmet needs may be identified and despite the development of new therapeutic strategies as well as a better understanding of the effects of existing therapies, many open questions still remain in this field, suggesting a research agenda for the future and specific clinical suggestions which may allow physicians to better manage those clinical conditions still lacking of scientific clarity.


Antiphospholipid syndrome; Biologic drugs treatment; Effectiveness; Remission; Rheumatoid arthritis; Sjogren's syndrome; Spondyloarthritides; Systemic lupus erythematosus; Systemic sclerosis; Unmet needs

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