Expert Interviews: Leading Immunologists on Autoimmune Disease Management
Learning directly from leading autoimmune disease specialists provides insights that transcend textbook knowledge and offer practical, experience-based guidance for daily management. The following synthesis draws from published interviews, conference presentations, and clinical commentary from prominent immunologists and rheumatologists who collectively represent centuries of clinical experience.
These expert perspectives address common patient questions, cutting-edge treatment approaches, and the practical wisdom that comes from caring for thousands of autoimmune patients.
Dr. David Fox on Treat-to-Target in RA
Dr. David Fox, Professor of Medicine at the University of Michigan and past president of the American College of Rheumatology, has been a leading advocate for the treat-to-target approach in rheumatoid arthritis.
“The days of starting methotrexate and waiting six months to see if it works are over,” Dr. Fox has noted in ACR conference presentations. “We now have the tools to assess disease activity objectively and adjust treatment systematically until the goal — remission or low disease activity — is achieved.”
Dr. Fox emphasizes that the treat-to-target approach requires regular disease activity assessment (every 1-3 months during active disease), predefined treatment goals based on validated measures, and willingness to escalate therapy if goals are not met. He notes that patients who achieve remission within the first year of treatment have the best long-term outcomes.
Dr. Betty Diamond on Lupus Research
Dr. Betty Diamond, Head of the Center for Autoimmune and Musculoskeletal Disease at the Feinstein Institutes for Medical Research, is a leading lupus researcher whose work focuses on the intersection of autoimmunity and neuroscience.
“Lupus is not just a joint and kidney disease — it affects the brain and nervous system in ways we are only beginning to understand,” Dr. Diamond has written in Nature Reviews Immunology. “Neuropsychiatric lupus affects up to 80% of lupus patients at some point, causing cognitive dysfunction, mood disorders, and in severe cases, psychosis.”
Dr. Diamond’s research demonstrates that anti-DNA antibodies can cross the blood-brain barrier and directly affect neuronal function, explaining neuropsychiatric symptoms that were previously attributed to “just stress” or “just depression.” This research is opening new therapeutic avenues targeting neuropsychiatric lupus specifically.
Dr. Josef Smolen on Biologic Optimization
Dr. Josef Smolen, Medical University of Vienna and past EULAR president, has published extensively on optimizing biologic therapy in autoimmune diseases. His research demonstrates that treatment sequencing affects long-term outcomes.
“The first biologic you try has the highest chance of success,” Dr. Smolen has stated in Annals of the Rheumatic Diseases. “If the first biologic fails, the second has a lower success rate. This is why treatment selection at the time of first biologic initiation should be thoughtful and evidence-based, not arbitrary.”
Dr. Smolen advocates for predictive biomarkers to guide biologic selection. His research suggests that anti-CCP-positive RA patients respond better to certain biologics, while seronegative patients may benefit from different approaches. The concept of “right drug for the right patient” is central to precision autoimmune medicine.
Dr. Victoria Werth on Dermatomyositis and Skin Autoimmunity
Dr. Victoria Werth, Professor of Dermatology and Medicine at the University of Pennsylvania, specializes in dermatomyositis and cutaneous autoimmune diseases.
“Skin involvement in autoimmune disease is often dismissed as cosmetic, but it can be the most disabling and distressing aspect for patients,” Dr. Werth has noted in Journal of the American Academy of Dermatology. “Dermatomyositis skin disease affects quality of life profoundly and can be refractory to standard immunosuppressive therapy.”
Dr. Werth’s research focuses on the unique immunology of skin autoimmunity, which differs from systemic autoimmune mechanisms. She advocates for skin-specific treatment approaches alongside systemic therapy, emphasizing that comprehensive autoimmune management must address all affected organ systems.
Dr. Daniel Mueller on Celiac Disease and Autoimmunity Prevention
Dr. Daniel Mueller, Director of the Celiac Disease Center at Columbia University, is advancing understanding of how celiac disease serves as a model for autoimmune disease prevention.
“Celiac disease is unique among autoimmune diseases because we know the environmental trigger — gluten — and can prevent disease through dietary intervention,” Dr. Mueller has written in Gastroenterology. “This model suggests that if we can identify triggers for other autoimmune diseases, prevention through trigger avoidance becomes possible.”
Dr. Mueller’s research explores whether early gluten introduction in genetically susceptible infants can prevent or delay celiac disease onset. The EAT-Study and similar trials are testing whether dietary modification during infancy can modulate autoimmune risk.
Dr. Joseph Murray on Autoimmune Disease Trends
Dr. Joseph Murray, gastroenterologist at Mayo Clinic and IBD researcher, has documented the increasing prevalence of autoimmune diseases worldwide.
“The global increase in autoimmune diseases cannot be explained by genetics alone — something in our environment is driving this epidemic,” Dr. Murray has stated in The Lancet. “Changes in diet, microbiome, chemical exposures, and infection patterns over the past 50 years are the most likely contributors.”
Dr. Murray’s research identifies specific environmental factors associated with increased autoimmune risk: antibiotic use in early childhood, Western dietary patterns, reduced microbial diversity, and altered infection exposures. He advocates for public health approaches to reduce autoimmune risk at the population level.
Integrating Expert Advice into Your Practice
The collective wisdom of these experts converges on several key themes: treat autoimmune disease early and aggressively, use objective measures to guide treatment decisions, personalize therapy based on individual disease characteristics, address the whole patient (physical, psychological, social), and stay engaged with evolving research and treatment options.
Frequently Asked Questions
How do I find a rheumatologist who practices evidence-based medicine?
Seek rheumatologists affiliated with academic medical centers who participate in continuing education through the ACR. Ask about their approach to treat-to-target, how they assess disease activity, and whether they use validated outcome measures. Board certification in rheumatology and active ACR membership indicate commitment to evidence-based practice.
Should I get a second opinion on my autoimmune treatment?
If your disease is not well-controlled despite treatment, or if you have concerns about your current approach, a second opinion from a rheumatologist at a different institution can provide valuable perspective. Different training backgrounds and clinical experiences may lead to different treatment recommendations.
What questions should I ask my rheumatologist at my next visit?
Ask about your current disease activity score, whether your treatment goal is being met, whether treatment escalation is needed, and what lifestyle modifications would have the greatest impact on your disease. Bring your portfolio summary and specific questions.
How do I stay current with autoimmune disease research?
Follow your disease-specific foundation’s research updates, subscribe to the ACR’s patient education newsletters, read PubMed alerts for your condition, and attend patient education sessions at ACR annual meetings. Your rheumatologist can help identify which developments are most relevant to your specific condition.
Are there autoimmune disease conferences for patients?
Yes. The ACR’s Annual Meeting includes patient education sessions. Disease-specific foundations host annual conferences (Lupus Foundation’s “Lupus Conferences,” Crohn’s & Colitis Foundation’s “Educational Seminars”). Many conferences offer virtual attendance options for those unable to travel.