Autoimmune Disease

Condition

What is an autoimmune disease?

The role of the immune system is to protect the body against invasion (infection). White blood cells recognize infectious organisms such as viruses, bacteria, fungus, etc. as ‘non-self’ or foreign, and mount an immune response to attack and eliminate them from your body.This means the immune system is ‘educated’ to know ‘self’ (i.e., lung, liver, heart, skin), and what is foreign to the body, or ‘non-self’. 

Autoimmune diseases arise when the immune system mistakes parts of the body as being foreign or ‘non-self’ and mounts an immune response against the body’s healthy cells, tissues, and organs. 

According to the National Institute of Health, 23.5 million Americans have autoimmune disease.

What are the different types of autoimmune diseases?

Autoimmune diseases can manifest anywhere in the body. Currently, physicians know about more than 80 autoimmune diseases. Some of the more well known autoimmune diseases are; Psoriasis, Inflammatory bowel disease (IBD), Vitiligo, Multiple sclerosis (MS), Type 1 diabetes, Rheumatoid arthritis, Celiac disease, Hashimoto’s thyroiditis, and Lupus, while others are rare and can be difficult to diagnose.

Flares  or "flare-ups" are a classic sign of an autoimmune condition. Flares are the sudden and severe onset of symptoms which can include redness, heat, pain, or swelling. Flares can be triggered by different factors, such as stress or sunlight. Knowing your triggers, following a treatment plan, and seeing a doctor regularly can help you manage your flares.

What causes autoimmune diseases?

Currently, scientists are not sure what causes autoimmune diseases, but have identified several contributors such as genetics, environmental factors, and sex (female vs male). 

Having a family history of autoimmune diseases such as lupus or multiple sclerosis raises your risk of developing autoimmunity. Moreover, some families have multiple members affected by different autoimmune diseases, while others never manifest (develop) such diseases.

Other factors in combination to genetic susceptibility have been associated with autoimmunity. These include:

  • some viral and bacterial infections
  • traumatic experiences and chronic stress
  • some medications
  • drug abuse
  • acute chemical exposures

Smoking obesity may worsen some autoimmune disorders and their symptoms by contributing to chronic systemic inflammation. Women are more likely than men to develop most autoimmune diseases. These sex differences vary by condition and range from women being twice as likely to develop autoimmunity, to women being nine times more likely, as is the case with lupus. Usually, the autoimmunity starts during a woman’s childbearing years (ages 15 to 44).

Autoimmune diseases are more common in certain ethnic backgrounds than others. Type 1 diabetes is more common in Caucasians while lupus is most severe in African American and Hispanic people. 

What role does hormones and the endocrine system have on autoimmune diseases? 

Sex-hormones, cortisol, vitamin D, and other hormones that affect how your immune system functions may also contribute to autoimmunity, but more research is needed to establish a causative link.

Women are more likely to develop autoimmune diseases including systemic lupus erythematosus (SLE), multiple sclerosis, rheumatoid arthritis, Grave’s disease, Hashimoto’s thyroiditis, and Sjögren’s syndrome. Several factors are likely responsible for these sex-differences in autoimmunity. Differences in estrogen and testosterone between men and women are thought to be contributors, but this hasn’t been proven.

Birth control, especially contraceptives with high estrogen content, have been linked to higher risk of developing autoimmune conditions including Crohn’s disease and lupus, or may increase their severity, but more research is needed to support these links. 

Vitamin D deficiency is often observed in people with autoimmune diseases. However, whether vitamin D supplementation protects against autoimmune disorders is not certain. Some report that low vitamin D levels result from autoimmune disorders, and supplementing with vitamin D may exacerbate these disorders. 

Common symptoms of autoimmune diseases/conditions

Autoimmune diseases share many symptoms in common. Inflammation is the central mechanism by which the immune system damages organs and tissues, which is associated with tenderness and pain. Other symptoms include

  • swelling and redness at site of inflammation
  • fatigue
  • fever
  • unexplained weight loss
  • rashes
  • muscle pain
  • joint stiffness that improves with activity and gets worse with rest
  • back pain at night that gets worse with rest and immobility

Most autoimmune diseases are episodic (occurring occasionally) in nature, meaning some will experience times of intense debilitating pain and other times of low-grade pain that is more manageable and may not interfere with daily tasks.Patients have also described hair loss in localized areas, and recurrent oral or nasal ulcers.

Treatment for autoimmune diseases and conditions?

Most autoimmune conditions are chronic and cannot be cured, but they can be controlled with treatment. Treatments will depend on the disease and symptoms. The goal of treatment is to control the autoimmune process, reduce symptoms, and maintain the body's ability to fight diseases. Autoimmune diseases that damage glands in our body that produce hormones may require lifetime hormone replacement. These include: 

For these diseases, hormone replacement therapy is needed to replace the hormones that a person can no longer make. In Graves’ Disease, medication is given to destroy the thyroid gland, and the patient will then take thyroid hormone replacement for the rest of their lives. More research is needed to establish whether hormone replacement therapy can help with other autoimmune diseases.

Managing an autoimmune disease/condition?

Since many autoimmune diseases share many symptoms, getting to a diagnosis can be a long, difficult, and stressful. Many symptoms of autoimmune diseases are the same for other types of health problems too. This makes it difficult for doctors to settle on a specific diagnosis. It is important not get frustrated and feel defeated by this process. Keep good notes on symptoms as they appear, pain level associated and how long these symptoms last.

Certain lifestyle changes can significantly improve the efficacy of physician prescribed medication. Smoking can have significant impact on the success of treatment. Smoking has been associated with increased risk for many autoimmune diseases including lupus, psoriasis, and rheumatic arthritis. In fact, people with a genetic susceptibility (shared epitope HLA-DRB1) for rheumatoid arthritis have a 36-fold increase risk for developing rheumatoid arthritis if they smoke. Moreover, smoking is known to interfere with the commonly prescribed drugs such as hydroxychloroquine.

While there is no causal link between obesity and development of autoimmune diseases, physicians recommend maintaining a healthy body weight. Studies have linked high body weight and a poor prognosis in rheumatoid arthritis patients.

Autoimmune diseases such as rheumatoid arthritis can make simple daily tasks such as removing the lid on a jar or turning a doorknob difficult due to the pain and deformation that can occur to the inflamed joints. Some patients have described changes in mood and depression because of changes to normal routines due to their autoimmune disease. People recently diagnosed with an autoimmune disease should seek professional help from therapist to help come to terms with their diagnosis and the possible lifestyle changes to come. Physicians also recommend working with physical and occupational therapist to learn how to use assistive devices.

While there is no definitive diet to prescribe for patients with autoimmune diseases, some foods have been shown to have anti-inflammatory effects for some autoimmune conditions. Most of the research investigating the association between diet and autoimmunity are currently being conducted in mouse models of lupus. Apart from maintaining a healthy body weight, the use of the polyunsaturated fatty acid Omega-3 has been shown to have a mild anti-inflammatory effect in randomized trials. Omega-3 fatty acids can be found in fish, canola oil, flaxseeds, soybeans and walnuts otherwise known as the Mediterranean diet. Nutritional supplements are an attractive therapeutic option that have shown some promise in early research for lupus therapy, but more research is needed.

Autoimmune disease and conditions are some of the most complex and hard-to-treat immune system-related diseases. As with most chronic conditions, it is important to minimize stress as this can increase the frequency and duration of ‘flares'.

Questions to ask your doctor

  • Are there any screenings or tests I need to determine the type of autoimmune condition I have?
  • What treatment options are available for my autoimmune condition?
  • Are there any alternative treatments that can help with my autoimmune condition?
  • How can I manage "flare ups" and how can I avoid or prevent "flare ups?"
  • Will my autoimmune condition affect reproduction/pregnancy?
  • Do I need to see a specialist such as: rheumatologist, dermatologist or endocrinologist?
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