The evolutionary trade-off between immunosurveillance and self-tolerance: Insights from four rheumatologic themes

Host-pathogen interactions have shaped the evolution of the human immune system, sometimes resulting in genetic and acquired trade-offs between robust immunosurveillance and refined self-tolerance. This review examines four representative elements, HLA-B27, tyrosine kinase 2, IL-23 signaling, and anti-citrullinated protein antibodies, to illustrate how these immune components are balanced against the costs of autoimmune disorders. By tracing their evolutionary trajectories, molecular functions, and clinical implications, we aim to elucidate the double-edged nature of immune defense mechanisms and highlight therapeutic opportunities.