[Between the normal and the pathological: The concept of pre-disease applied to systemic autoimmune rheumatic diseases]

The incidence of systemic autoimmune diseases is constantly rising. They are chronic diseases requiring prolonged treatment, with considerable psychosocial impact. While attention to the promising results obtained with CAR-T cells in refractory patients is justified, it seems important not to overlook the opportunities for prevention based on the identification of a pre-disease state. After clarifying the various stages that make up this pre-disease state, using the prototypical example of systemic lupus erythematosus, we will apply a transdisciplinary and transpathological approach to describe comparatively recent data obtained for other systemic autoimmune diseases (rheumatoid arthritis, Sjögren's syndrome and systemic scleroderma). We will then discuss the practical implications of this new paradigm in the typical consultation of a potentially "pre-sick" individual, and on the prospects opened up by this new paradigm in care and research.