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Chapter 97 : Introduction
Autoimmunity is common, while autoimmune disease is not. It is not clear how or why a benign autoimmune response becomes “malignant,” thereby leading to pathogenic changes of a target organ. Few autoimmune diseases fulfill the strict criteria by which the autoimmune response is directly related to pathogenesis. However, many findings, either cellular or humoral, can provide strong circumstantial evidence that autoimmunity is strongly associated with a particular disease. Often, the humoral responses detected in the laboratory are best considered to be markers rather than causes of disease. The autoantibodies are useful for diagnosis or prognosis, for excluding other conditions, for classifying disease, or for monitoring therapy. Whenever we test for autoimmune disease by evaluating autoantibodies, we must consider that individuals without evidence of disease may also exhibit these autoantibodies. Therefore, all results must be evaluated in context with the entire clinical picture; autoantibodies are rarely the sole criterion for disease. However, since autoantibodies are a significant marker of disease, often developing years before symptoms are present, the autoantibodies may indicate future disease.