Modern Strategies for Early Detection and Management of Multisystem Diseases
Abstract
Multisystem diseases affect several organ systems, either simultaneously or sequentially, and include systemic autoimmune and inflammatory diseases such as systemic lupus erythematosus, systemic sclerosis, vasculitis and sarcoidosis; infiltrative diseases such as amyloidosis; chronic infections such as tuberculosis and HIV; and interconnected metabolic disorders such as the cardiovascular–kidney–metabolic syndrome. Their presentation is often non-specific and varies widely between patients, and early features may be seen by different specialists who do not connect them. As a result, diagnosis is frequently delayed, by which time irreversible organ damage may have occurred. This review summarises modern strategies for earlier detection and better management of multisystem diseases. Early detection relies on recognising clinical "red flags" and patterns, using validated classification criteria, autoantibody and biomarker testing, and organ-specific screening, such as annual echocardiography and pulmonary function testing in systemic sclerosis. Advanced imaging, including cardiac magnetic resonance, positron emission tomography and nuclear scintigraphy, has transformed the non-invasive diagnosis of cardiac sarcoidosis, large-vessel vasculitis and transthyretin cardiac amyloidosis. Genomic testing, artificial intelligence and electronic health record-based alert systems may further shorten diagnostic delays. Management has moved towards treat-to-target strategies, early use of disease-modifying and biologic therapies, steroid-sparing regimens, organ-protective treatments and disease-specific agents such as tafamidis for transthyretin amyloidosis. Multidisciplinary clinics, coordinated care pathways, patient education and long-term surveillance for complications are essential. Challenges include limited awareness, access to specialised tests and therapies, cost and fragmented care. Integrated, patient-centred models of care are key to improving outcomes.
