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132 Larreal y Vargas
Investigación Clínica Vol. 65(2): 2024
afectar en diferentes momentos y maneras,
la homeostasia del individuo
8
, y aunque se
describan principalmente como desencade-
nantes de la enfermedad, los virus podrían
representar solo la parte más visible de la
tautología autoinmune y del mosaico de la
autoinmunidad.
Aunque los trastornos autoinmunes son
comparativamente raros, su incidencia y pre-
valencia en todo el mundo está aumentando,
y tienen importantes implicaciones adversas
en la morbimortalidad de la población. Su
expresión clínica es diversa, y son muchas
las enfermedades asociadas a autoinmuni-
dad, entre las que resaltan: la diabetes Tipo
1, la artritis reumatoidea y las artritis sero-
negativas, el lupus eritematoso sistémico, la
polimiositis, el síndrome de Sjogren, la uveí-
tis, la tiroiditis, la enfermedad de Crohn, la
colangitis biliar primaria, la hepatitis auto-
inmune, las miocardiopatías, la anemia he-
molítica autoinmune, las púrpuras de origen
inmunitario y la esclerosis múltiple, entre
otras. Son muchos los reportes en la litera-
tura, posteriores a COVID-19, sobre casos de
enfermedades autoinmunes de nueva apari-
ción, en pacientes sin antecedentes de auto-
inmunidad
9
.
Este escenario complejo, se refleja tam-
bién en el diagnóstico de laboratorio, pues
son necesarias varias pruebas para validar
esta asociación; por una parte, los polimor-
fismos genéticos que determinan la mayor
susceptibilidad a una enfermedad, por otra
parte, la confirmación del posible agen-
te disparador y finalmente, la certificación
de la enfermedad autoinmune. Una prueba
diagnóstica puede carecer de especificidad
y sensibilidad, aunque ayude a estimar la
gravedad de la enfermedad y a evaluar su
pronóstico y actividad. Tal es el caso de la
detección de autoanticuerpos en individuos
sin un diagnóstico concluyente de enferme-
dad autoinmune. Por otro lado, se han hecho
esfuerzos en tratar de identificar factores de
riesgo clave y posibles biomarcadores, que
permitan hacer un diagnóstico enfocado en
la susceptibilidad de los individuos, tomando
en cuenta la exposición al medio ambiente y
basándose en estudios epidemiológicos y clí-
nicos, que utilizan pruebas toxicológicas, mi-
crobiológicas, bioquímicas e inmunológicas.
Al respecto, existen evidencias significativas
que vinculan una enfermedad autoinmune
particular, con agentes ambientales específi-
cos
8
, aunque se cree que este enfoque sería
más útil en enfermedades autoinmunes con
etapas subclínicas largas y estados frecuen-
tes de remisión-recaída.
El período de tiempo entre una infec-
ción viral y el inicio de la autoinmunidad es
variable; la aparición de un cuadro infeccio-
so, eventualmente crítico, puede ser extre-
madamente difícil de detectar. Una vez que
se establece la enfermedad autoinmune, di-
fícilmente se regresa al estado de equilibrio
anterior, y es necesario en la mayoría de ca-
sos, algún tipo de tratamiento permanente.
Han sido muchos los tratamientos propues-
tos para controlar esta respuesta inapropia-
da del sistema inmunitario, la mayoría de
ellos con efectos adversos importantes; sin
embargo, la inmunoterapia ha abierto nue-
vos caminos. Es necesario promover más in-
vestigación básica sobre los mecanismos mo-
leculares de las enfermedades autoinmunes,
para que avances como la vacuna inversa y las
nanopartículas, sean plenamente efectivos.
De igual manera, es imperioso un abordaje
multidisciplinario, desde el conocimiento de
la predisposición genética, el mayor control
de disparadores ambientales (entre ellos los
virus), hasta la mayor equidad en cuanto al
acceso de las nuevas terapias biológicas para
el tratamiento, que contribuya a mejorar la
calidad de vida de estos pacientes.
Yraima Larreal
ORCID 0000-0003-0862-9842
Renata Vargas
ORCID 0009-0007-0598-6971