Imagine that your own immune system without apparent cause “activates” causing an inflammatory response that mistakenly attacks and inflames different healthy parts of your body such as organs, joints, skin…
As a consequence of this inflammatory response, a serious chronic pathology occurs that will affect your quality of life both physically and psychologically. A pathology, furthermore, that can end up co-occurring with other similar ones and, instead of one chronic disease, you end up having several at the same time.
This is the reality that 6 out of every 100 people live in Spain, affected by what are known as Immune-mediated Inflammatory Diseases (IMID).
“IMIDs are diseases that are known as immune-mediated because they are related through immunity and can affect different organs of the human body: the skin, the joints, the central nervous system…”, explains Dr. Elena Ricart, head of the Inflammatory Bowel Disease Unit of the Hospital Clínic of Barcelona.
The main peculiarity of IMIDs is their heterogeneity, since they involve more than 100 pathologies. A fact that, according to Dr. Mireia Moreno, an expert in rheumatology at Parc Taulí Hospital Universitari, implies many challenges for both patients and professionals: “The fact of affecting so many systems implies having a lot of knowledge of everything,” she says.
They can encompass many different types, from dermatological, such as psoriasis, to rheumatological ones such as spondyloarthritis or inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease.
Therefore, the multidisciplinary approach is presented as one of the best tools for the proper management of this type of pathologies that currently affect 2.5 million people in Spain.
“Apparently they are not related,” says Dr. Lluís Puig, head of the dermatology service at the Hospital de la Santa Creu i Sant Pau. However, these chronic inflammatory diseases can generate a domino effect since, once one appears, there is the possibility of more manifesting.
The very heterogeneity of IMIDs is what causes a great possibility of ‘domino effect’, that is, what is called by the term “co-occurrence”. “The co-occurrence is that a patient who has one IMID is not uncommon to have several. For example, a patient with Crohn’s disease also has spondyloarthropathy or psoriasis,” explains Dr. Ricart.
Having an immune-mediated inflammatory disease does not necessarily mean being able to add another; however, 10% of patients have been diagnosed with two or more coexisting IMIDs.
Therefore, this fact forces both patients and professionals to be extremely vigilant.
IMIDs require great attention and monitoring both due to the nature of each pathology and due to other pathologies that may manifest in the same patient. They may suffer from comorbidities and complications derived from the chronic effects of inflammation, cardiovascular risk factors, metabolic syndrome or kidney diseases.
“For example, psoriasis can be associated with psoriatic arthritis, as well as other metabolic and intestinal diseases. Atopic dermatitis or eczema can be a way of activating other diseases such as, for example, asthma,” explains Dr. Puig.
For Dr. Puig, IMIDs not only impact quality of life due to the inflammation they produce, but also due to side effects such as psychological effects. “Often, ailments such as psoriasis obviously alter a person’s image and this can affect their ability to socialize and even develop in the workplace,” he points out. Although IMIDs can affect both men and women, they do have a higher prevalence in them (7.4% compared to 5.4% in men).
Professionals warn about how they increasingly appear at younger ages. “It really means that the pathology accompanies them throughout life. If you already accompany a ‘healthy’ person as a doctor throughout their life and as time progresses things appear, with an IMID you accompany them because you have to control that others do not appear. You have to change habits, explain the information… It’s a whole ‘complete package,'” says Dr. Moreno.
“We must be especially sensitive to the implications that these inflammatory diseases have on patients, taking into account that the impact is very different in groups such as pregnant women, adolescents or the elderly. IMIDs belong to that group of diseases that do not kill, but can cause even greater damage than fatal diseases,” explains Dr. Puig.
That is why the patient must be absolutely involved. Without having to scare him, but constantly inform him about the situation, according to Dr. Moreno.
The very idiosyncrasy of IMIDs provides a positive factor in the care relationship: they place the individual at the center.
“It had reached a point where we were so specialists in each thing that at some point we had lost ourselves in the individual. The idea of ??global approach is making a comeback with IMIDs. “You must have a lot of knowledge of the different possibilities of involvement to at least know how to detect them and send patients to the appropriate specialist,” explains the rheumatologist.
Thus, the multidisciplinary approach shines as the main tool to improve the quality of life of patients with these diseases.
As the consequences can be diverse due to the heterogeneity of IMIDs, a multidisciplinary approach is key to ensure adequate management. It is a planned approach to treatment where different doctors, specialists in different disciplines, intervene in a coordinated manner.
The consensus among professionals is practically absolute. “These diseases share many pathogenic pathways of the disease, so this type of origin is often common. This means that treatments can often be common or, if not, very similar. So to treat multiple IMIDs you can use one drug that controls everything. Therefore, it is very important that the specialties that deal with all these diseases agree to assess which is the best treatment to cover all the patient’s needs,” explains Dr. Ricart.
The digestologist at the Hospital Clínic of Barcelona remembers that the multidisciplinary approach can be very varied. However, the objective is common: “that the different specialists agree on the best possible therapy for each specific patient. “It is about interrelating between different specialties that treat very similar diseases.”
This method makes the work of professionals much easier, while at the same time it has a great impact on the patient. “Disciplinary consultations speed up everything in a brutal way, you establish more agile circuits for the diagnosis process and rule out that there is no other associated IMID,” highlights Dr. Moreno.
One of the most important aspects is that the approach not only offers more complete follow-up and treatment to patients, but also improves the relationship between doctors. “We specialists are more up-to-date regarding other specialties, not just ours. It also helps us a lot to coordinate treatments, follow-up and strengthen the patient in the face of the habits that he has to change if necessary. Even for research. Everything is much more related,” develops the rheumatologist at the Parc Taulí Universitari Hospital.
The multidisciplinary approach is a methodology that favors the involvement of all therapeutic areas, so the care process improves exponentially. The positive feelings can not only be seen among professionals, but patients, who are still the true protagonists of IMIDs, value them first-hand.
“The patient feels very well treated. He has a super high level of satisfaction, it’s like you empower him in some way. Everyone benefits, proof of this is that in all the international guides and recommendations of the different specialties that we are involved in IMIDs there is a tendency to be multidisciplinary. There are different types: agile circuits, face-to-face multidisciplinary, parallel… But the point is that they exist,” explains Dr. Moreno.
While it is true that a multidisciplinary approach is the best tool to combat IMID, it is not all easy.
From a basic point of view, one of the most important aspects for the effectiveness of multidisciplinarity to be high is to diagnose diseases as soon as possible. “We have seen that the sooner we detect an IMID and begin to make an intervention, including changing habits, the response to treatments and the associated comorbidity improve. Early detection is very important and all this improves with multidisciplinarity,” says Moreno.
Dr. Lluís Puig completely agrees with Dr. Mireia Moreno: “The fundamental thing is to be able to make a quick and accurate diagnosis that allows us to identify the diseases involved to know which specialties should intervene.”
For Dr. Moreno, several factors come together when it comes to being able to carry out a multidisciplinary approach, such as the space where consultations can be carried out or to make managers understand the situation. For the doctor, it also depends on each center: “The implementation of multidisciplinary teams depends a lot on each center, on each health system. We don’t have the same resources. You try to adapt the situation to what each center and each hospital has.”
However, despite the difficulties that professionals may encounter, the message regarding IMIDs is clear. The multidisciplinary approach is essential to improve the quality of life of patients, who are more satisfied thanks to this methodology.
If your body attacks you, the answer is to understand why it does so from various perspectives and respond globally, with an entire arsenal of care, research and transversal pharmacology.