Two patients. One disease. Yet neither patient experiences the disease in the same way. One may visit a dermatologist for a persistent rash, while another may see a primary care physician for debilitating fatigue. This reality is arguably one of the greatest challenges in caring for patients with systemic lupus erythematosus (SLE or lupus), whose diverse manifestations often require care across multiple specialties. As I explored emerging lupus research and spoke with rheumatologist Dr. Iqra Aftab, I realized that lupus offers a window into the future of healthcare: precision medicine. By revealing each patient's biology, biomarkers may help physicians treat the mechanisms driving disease rather than simply managing symptoms. Yet significant challenges remain before that vision becomes routine clinical practice.
Why Broad Treatments Can Fall Short in Lupus
SLE is an autoimmune disease characterized by immune dysregulation, but that dysregulation manifests differently across patients. Dr. Aftab described lupus as a disease that may appear clinically similar while being very different "under the hood," helping explain why patients with similar symptoms may respond differently to the same medication (Aftab, 23:40). That reality is reflected in my own family, where both my grandmother and aunt have lupus but experience entirely different manifestations.
Many current therapies broadly suppress inflammation without selectively targeting the biological pathways driving disease in an individual patient. As Dr. Aftab explained, lowering immune activity may reduce lupus inflammation, but it can also "risk putting patients at a higher risk of infection" (Aftab, 25:18). This conflict—relieving inflammation without compromising immune function—highlights the need for tools that can identify the mechanisms most relevant to each patient.
How Biomarkers Can Guide More Precise Lupus Care
If different biological pathways drive SLE in different patients, a pertinent question arises: how can physicians identify those differences? Biomarkers offer one promising solution. These measurable biological indicators provide information about disease state or underlying processes. In lupus, these may include proteins in the blood, autoantibodies, genetic signatures, or other assessable changes that reflect immune activity.
Researchers are investigating whether increasingly precise biomarkers can identify mechanisms leading to disease activity, predict when flares will arise, and guide individualized treatment decisions. Rather than replacing clinical judgment, Dr. Aftab emphasized that biomarkers should complement it, with physicians interpreting the results alongside a patient's symptoms, history, and examination. As biomarkers improve, physicians may be able to move beyond today's trial-and-error approach by identifying the pathways behind an individual's disease.
Additionally, biomarkers may be more valuable the earlier they are used in the course of a patient's disease. Dr. Aftab described a "window of opportunity" before chronic inflammation causes irreversible organ damage (Aftab, 7:03). Timely recognition and referral by primary care physicians and other specialists are especially important because, as she summarized, "Time is organ" (Aftab, 13:08). Therefore, the longer diagnosis and treatment are delayed, the greater the risk of permanent organ damage.
Limitations in Current Use of Biomarkers
Clinicians already rely on biomarkers such as antinuclear antibodies (ANAs) and complement levels for diagnosis and disease monitoring. However, Dr. Aftab noted that "these biomarkers are still quite broad" (Aftab, 20:48). The next frontier is developing tools that can identify the specific immune pathway driving inflammation. If clinicians can determine whether a patient's disease is driven primarily by type I interferon signaling or another pathway, they may be able to select a treatment tailored to that mechanism. Cell-bound complement activation products (CB-CAPs), as one example, are being investigated for their ability to predict flares and tissue damage (Arriens et al., 2017).
Beyond their limited specificity, several barriers must be overcome before biomarkers enter routine practice. Dr. Aftab highlighted the challenges of translating clinical-trial findings to real-world populations and making testing affordable and accessible. She also emphasized that improving biomarker research requires greater representation of populations disproportionately affected by lupus, particularly African American and Hispanic patients, in clinical trials (Aftab, 16:10). These barriers do not diminish the promise of biomarkers; instead, they define the research needed to make precision medicine useful, accessible, and equitable.
Why Precision Medicine Matters for the Future of Healthcare
Biomarkers are reshaping medicine by revealing how an individual patient's biology can guide clinical decision-making. As I prepare for a career in medicine, the shift from the one-size-fits-all approach to targeted treatments has changed how I view patient care. Medicine is no longer only about mastering disease; it is also about understanding the biological nuances that make each patient unique. The progress being made with biomarkers in SLE illustrates how understanding disease biology could become a defining development in the next era of medicine—not only by enabling more personalized treatments, but also by empowering physicians across specialties to deliver coordinated and individualized care.
Yet one lesson from my conversation with Dr. Aftab stood out. As precision medicine advances, physicians will have access to more data than ever before. However, she cautioned that medicine should never rely on numbers alone. Biomarkers should support—not replace—the conversations physicians have with their patients. For me, that perspective captures the true promise of precision medicine: treating the mechanisms driving disease rather than the symptoms resulting from it, while remaining firmly rooted in patient-centered care.
References
Arriens, C., Wren, J. D., Munroe, M. E., & Mohan, C. (2017). Systemic lupus erythematosus diagnostics in the era of biomarkers. Biomarkers in Medicine, 12(8), 857–875. https://doi.org/10.2217/bmm-2018-0098
