Advances in Systemic Lupus Erythematosus: the Promises and Pitfalls of Personalized Medicine and Patient Stratification

Systemic lupus erythematosus (SLE) is a complex multisystemic autoimmune disease. Multiple pathways have been identified as key players in the pathogenesis of SLE: from B cells and autoantibodies to interferons, innate immune cells, apoptosis, and necrosis pathways. Clinically, the heterogeneity of SLE is evident in its multisystemic nature and protean clinical manifestations. Notwithstanding a clear improvement in the treatment of SLE in recent years, for decades no therapies for new specific targets have been approved. Many promising drugs have failed to show efficacy in clinical trials. One of the reasons for this can be ascribed to the heterogeneous nature of SLE: multiple pathogenetic pathways may have a crucial role only in specific disease features (i.e. type I interferons in skin disease), an aspect that is often disregarded in clinical trials. Successful stratification of patients into homogenous groups would increase the efficiency and success of clinical trials, enable the development of tailored approaches, and improve the overall outcome of patients by reducing the number of ineffective, possibly harmful therapies and by a faster attainment of remission. Moreover, patient stratification would allow for tailored comorbidity screenings and follow-up monitoring.

The main goal of this research topic is to deconstruct the clinical and biological heterogeneity of SLE. Biomarkers are promising tools to stratify patients with common features and pathogenetic mechanisms. Biomarkers can be any kind of bio-humoral, imaging, or clinical parameter that can identify patients with common features. Thus, biomarkers may have a crucial role in identifying response to treatment, the risk of developing complications, and in establishing a long-term prognosis. The development of tools for patient stratification is a long and challenging process, highly needed to improve patient care.

In this Research Topic, our aim is to focus on biomarkers and precision medicine in SLE. We are interested in studies concerning biomarkers and other tools for patient stratification for prognosis, organ involvement, treatment strategies, and outcomes. Considering the wide range of manifestations of SLE, we welcome authors from the field of rheumatology and also from different subspecialties with an interest in SLE research (cardiology, nephrology, pulmonology, dermatology, neurology, etc.). We encourage authors to submit high-quality articles, addressing the key challenges in SLE stratification for prognosis, treatment, and follow-up. All types of articles tackling and dissecting the present research topic are welcome.