Consensus Interpretation | The Value of Cytokine Testing in Immune-Mediated Inflammatory Diseases

Recently, the Chinese Medical Journal released the "Expert Consensus on Multidisciplinary Management of Immune-Mediated Inflammatory Diseases (2026 Edition)." Developed jointly by experts in rheumatology and immunology, dermatology, gastroenterology, and pharmacy, the consensus establishes a multidisciplinary team (MDT) diagnosis and treatment system for IMID.

The consensus not only defines a new pathway for IMID diagnosis and treatment but also highlights the core value of cytokine testing in disease management, providing key support for precision diagnosis and treatment in clinical practice.

■ Understanding IMID: A Family of Diseases Spanning Multiple Disciplines

Immune-mediated inflammatory diseases (IMIDs) are a group of chronic inflammatory, systemic diseases triggered by immune imbalance, encompassing over a hundred conditions including rheumatoid arthritis (RA), psoriasis (PsO), psoriatic arthritis (PsA), axial spondyloarthritis (axSpA), atopic dermatitis (AD), and inflammatory bowel disease (IBD).

In 2019, the overall age-standardized incidence rate of IMID in China had reached 835.34 per 100,000 population.

The consensus points out that IMIDs share two notable characteristics: first, they often involve multiple organs or systems; second, there are obvious common pathogenic mechanisms among the diseases. Data show that 5.8% of patients with atopic dermatitis, 24.3% of patients with rheumatoid arthritis, and 22.5% of patients with inflammatory bowel disease have other IMID comorbidities. This state of multiple coexisting diseases significantly increases the disease burden and the difficulty of diagnosis and treatment.

■ Cytokines: The Core Hub of IMID Pathogenesis

The consensus systematically elaborates on the pathogenesis of IMIDs, emphasizing that multiple inflammatory cytokines play key roles, including the interleukin (IL) family, the tumor necrosis factor (TNF) family, and interferons (IFN).

Of particular note is the JAK-STAT signaling pathway — the common downstream pathway of multiple inflammatory cytokines including the IL family and IFNs. It mediates the transmission of extracellular signals to the nucleus and serves as a key inflammatory hub in the pathogenesis of multiple IMIDs.

Blocking the JAK-STAT signaling pathway can affect the activation of multiple cytokine families. The consensus notes that this mechanism enables targeted therapy to intervene in multiple IMIDs simultaneously. The main cytokines involved in different IMIDs are shown in Table 3 (embedded figure in the original web page).

■ Multidisciplinary Management: Key Application Scenarios of Cytokine Testing

The consensus strongly recommends establishing an IMID multidisciplinary team (MDT) diagnosis and treatment system, particularly for patients with severe multi-system involvement, patients with progressive disease worsening, and patients for whom treatment decisions are difficult. Within this system, cytokine testing can play the following important roles:

① Aiding early diagnosis and differential diagnosis

The consensus emphasizes that when patients present with initial IMID symptoms, other common IMID symptoms should be systematically screened at the same time. Cytokine profiling can help identify potential comorbidity risks. For example, psoriasis patients presenting with joint pain or low back pain should be alerted to the possibility of progression to psoriatic arthritis, and cytokine testing can provide objective evidence of the immune activation state.

②Guiding individualized treatment decisions

The consensus recommends prioritizing drugs that act on inflammatory hubs. For example, JAK inhibitors can target the JAK-STAT signaling pathway and suppress the expression of multiple inflammatory cytokines.

For patients with multiple coexisting IMIDs, JAK1 inhibitors may be the preferred option. Cytokine profiling before treatment can help predict patient responses to different targeted drugs.

③Monitoring treatment response and disease activity

The consensus recommends evaluating treatment efficacy every 4 weeks for patients in the active phase and every 3–6 months for those in the inactive phase.

Dynamic cytokine monitoring can objectively reflect changes in inflammatory burden, earlier than clinical symptom improvement or worsening, providing timely evidence for treatment regimen adjustment.

④ Early warning of "immune drift"

The consensus particularly cautions that during targeted immunotherapy, some patients may experience "immune drift" — a change in the cytokines that dominate the pathogenic mechanism, giving rise to clinical manifestations of other IMIDs.

Studies show that 2.2%–12.1% of psoriasis patients treated with IL-17 inhibitors develop eczematous skin lesions; among atopic dermatitis patients treated with dupilumab, 1.88%–7.00% may develop psoriasiform lesions. Regular monitoring of changes in the cytokine profile can help identify immune drift early and adjust treatment strategies promptly.

■ Cytokine Testing: An Important Tool for Precise IMID Management

Based on the consensus's systematic elaboration of IMID pathogenesis and diagnosis/treatment management, cytokine testing holds significant value throughout the entire IMID management journey:

Diagnostic stratification — identifying different IMID subtypes and assessing comorbidity risk through cytokine profile analysis;

 Treatment decisions — selecting the most suitable targeted drugs based on cytokine expression levels;

Efficacy monitoring — dynamically evaluating treatment response to guide regimen optimization; 

Prognosis assessment — providing early warning of immune drift and disease relapse risk.

The release of the "Expert Consensus on Multidisciplinary Management of Immune-Mediated Inflammatory Diseases (2026 Edition)" marks China's IMID management entering a new stage of multidisciplinary collaboration and precision diagnosis and treatment.

As the core mediators of IMID pathogenesis and key targets of targeted therapy, cytokines — and their testing — have irreplaceable value throughout the entire IMID management journey.

Hotgen Biotech's 14-plex cytokine testing panel, including TNF-α, IFN-γ, IFN-α, IL-1β, IL-2, IL-2R, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17A, and IL-22, comprehensively covers the core cytokines relevant to IMIDs. It provides a powerful tool for precise multidisciplinary IMID management, helping clinical practice achieve the goals of full-cycle management — early diagnosis, precise treatment, and dynamic monitoring — ultimately improving patients' long-term prognosis.