IntroductionAutoimmune diseases (ADs) are a heterogeneous pathology characterized by abnormalities in both humoral and cell-mediated immunity, resulting in their assault on normal bodily constituents, which leads to inflammation, cell injury, or a dysfunction with clinical manifestations in specific target organs (1). Historically perceived as rare, epidemiological revelations over the last two decades, particularly in Western countries, show a rise in the global prevalence of ADs (2-4). A recently published British population-based study highlights this trend, indicating that ADs afflict nearly 10% of the population, with an average age of onset at 54 years and a female predilection (2:1) (5). Predominant among these diseases are autoimmune thyroid disorders and type 1 diabetes, followed by systemic lupus erythematosus, rheumatoid arthritis, psoriasis, multiple sclerosis, celiac disease, and inflammatory bowel diseases (3,6). Globally, Graves' disease, celiac disease, and rheumatic disorders have witnessed the most substantial increases in incidence (5). Autoimmune skin disorders, comprising vitiligo, psoriasis, alopecia areata, bullous diseases, and systemic lupus erythematosus, have similarly experienced an escalating path (7). With genetic factors remaining constant, detailed scrutiny has shifted toward exploring environmental influences as potential contributors to the increasing prevalence of ADs. Ongoing evidence points to significant alterations in diet, xenobiotics, air quality, infections, personal lifestyles, stress, and climate change as factors precipitating the surge in AD incidence (8).Polyautoimmunity (PAI) is defined as the presence of more than one AD in an individual. PAI can be overt (fulfilling clinical criteria) or latent (presence of unrelated autoantibodies without clinical criteria fulfilment of the AD), and it can affect one or more organ systems. Various ADs tend to cluster together in specific patterns, suggesting shared genetic susceptibility traits (5). However, the clinical relevance within these clusters of ADs remains unclear (particularly in terms of management and outcome). PAI occurs in 25% to 34% of individuals with ADs, and familial autoimmunity, especially in females, is a predisposing factor for PAI. The observed female predilection is attributed to hormonal fluctuations and genetic disparities-both