What is the Immune System?
In order to understand autoimmune diseases, it is important to know how the immune system should normally work. The immune system is a network of cells, tissues, and organs that work together to protect the body from infection. Its main jobs are to protect your body from foreign invaders like bacteria and viruses, and to tell the body what is a threat and what is not. When you have a cold, for example, your body recognizes the virus as a foreign invader. This prompts a type of immune response sending the immune system’s white blood cells to remove the infection by producing proteins, called antibodies, that attack the intruders (called antigens).
What are Autoimmune Diseases?
As described above, your body’s immune system protects you from disease and infection.But if you have an autoimmune disease, your immune system cannot tell the difference between the healthy cells and the harmful cells in your body. The immune system becomes overactive and attacks and destroys the healthy cells by mistake. It does this by producing antibodies that target the body’s tissue. This is called autoimmunity.
When the disease affects multiple organs, as in systemic lupus erythematosus, it’s called a systemic autoimmune disease. If it affects only one organ or type of tissue, such as in type 1 diabetes, it is called a localized autoimmune disease. Autoimmune diseases can affect many parts of the body and can also cause abnormal growth and changes in organ function.
With allergies, also caused by an immune response, the body overreacts and responds negatively to external factors like dust, dander, and grass. With autoimmune diseases, the body responds and overreacts.
What Are Some of the Most Common Autoimmune Diseases?
Here is an alphabetical list of the most common autoimmune diseases (although with over 80 different types of autoimmune diseases, there are many, many more than the ones in this list!):
- Addison’s disease: Characterized by adrenal hormone insufficiency, Addison’s disease can lead to muscle weakness and fatigue, weight loss, low blood pressure, low blood sugar, nausea, irritability, and depression.
- Celiac disease: Celiac disease is a reaction to gluten (found in wheat, rye, and barley) that causes damage to the lining of the small intestine.
- Graves’ disease: This is when the thyroid gland becomes extremely overactive. People who have Graves’ disease may have difficulty sleeping, irritability, unexplained weight loss, bulging of the eyes, sensitivity to heat, muscle weakness, brittle hair, light menstrual periods, and shakiness of the hands. On the other hand, some people with Graves’ disease may experience no symptoms at all.
- Hashimoto’s disease: This is characterized by inflammation of the thyroid gland. Although sometimes no symptoms occur, Hashimoto’s thyroiditis often results in a goiter (enlargement of the thyroid gland, which may be visible as a bulge in the neck), fatigue, weight gain, depression, muscle weakness, cold sensitivity, dry hair and skin, and constipation.
- Inflammatory bowel disease: This refers to a group of inflammatory diseases of the colon and small intestine.
- Multiple sclerosis: This disease affects the brain and spinal cord. People who have MS may experience weakness, trouble with balance and coordination, problems speaking and walking, paralysis, tremors, and numbness in the extremities.
- Pernicious anemia: An inability to absorb vitamin B12 causes a decrease in red blood cells.
- Psoriasis: This isa skin condition that causes redness and irritation as well as thick, flaky, silver-white patches.
- Raynaud’s Phenomenon: People with Raynaud’s have a problem with blood flow, resulting in numbness, discoloration, tingling of the fingers, toes, and tip of the nose with exposure to cold temperatures.
- Reactive arthritis: This can cause inflammation of joints, the urethra, and eyes; may also cause sores on the skin and mucus membranes.
- Rheumatoid arthritis: In rheumatoid arthritis, autoimmunity causes the immune system to attack tissues in the joints.It typically affects the small joints in your hands and feet causing painful swelling, stiffness and loss of movement in the joints that can eventually result in bone erosion and joint deformity.
- Scleroderma: This connective tissue disease causes changes in skin, blood vessels, muscles, and internal organs. The word Scleroderma actually means “hardening of the skin”.
- Sjögren’s syndrome: This disease destroys the glands that produce tears and saliva causing dry eyes and mouth; may also affect the kidneys and lungs.
- Systemic lupus erythematosus: In lupus, antibodies made by the immune system attack the body. This disease can affect skin, joints, kidneys, brain, and all other organs.
- Type 1 diabetes: In Type 1 diabetes, the immune system attacks cells in the pancreas that produce insulin. When your insulin levels are insufficient, your body cannot control your glucose level, which can lead to a number of problems, including kidney failure, vision loss, circulation problems, stroke, and heart disease.
It is common for several autoimmune diseases to occur simultaneously in one person. These are often called “overlap” diseases. In lupus, for example, it is very common to have several of the above diseases overlap.
Who gets Autoimmune Diseases?
According to the American Autoimmune Related Diseases Association (AARDA), autoimmune diseases affect up to 50 million Americans. Researchers aren’t sure why, but the prevalence of autoimmune diseases seems to be increasing.
Although autoimmune diseases can affect anyone at any age, here are some populations who may be at greater risk:
- Women of childbearing age (approximately 14-44 years): More women than men have autoimmune diseases, which often start during their childbearing years.
- People with a family history of autoimmune disease: Some autoimmune diseases can run in families, such as multiple sclerosis and lupus. It is also common that different members of a single family can be affected with different types of autoimmune diseases.Genetic predisposition can make it more likely that an autoimmune disease can be inherited. The combination of both genes and other perhaps external, factors may trigger the disease to start.
- Environmental factors: Certain events or environmental exposures may cause some autoimmune diseases or make them worse.Some of the environmental factors that could play a role in the development of autoimmune diseases are: sunlight, chemicals or solvents, and viral and bacterial infections.
- People of certain races or ethnic backgrounds: Some autoimmune diseases are more common or more severely affect certain groups of people more than others. For instance, type 1 diabetes is more common in Caucasians. Lupus is most severe for African-American, Asian, Native American and Hispanic people.
What Causes Autoimmune Conditions?
No one is absolutely sure what causes autoimmune diseases. Much more research is needed and ongoing to fully understand them. There are, however, many ideas and theories about what may trigger an autoimmune disease. Although heredity and genetics are thought to be contributors, as autoimmune diseases often run in families, here are some of the other theories being questioned and studied:
- bacteria or virus
- chemical irritants
- some drugs
- environmental irritants
- certain foods
- certain hair dyes
One common theory across all of the autoimmune diseases is that some outside agent is required to start the process. Even with a genetic tendency, a person may not develop an autoimmune disease without an environmental influence or physical trauma to set it off. Here is a list of possibly identified suspects for some common autoimmune conditions:
- Lupus: hair dye and certain drugs, smoking
- Scleroderma: silica exposure
- Diabetes: gluten, coxsackie virus
- Rheumatoid Arthritis: mycoplasmas, smoking
- Epstein-Barr: measles virus
- Thyroid: smoking
- Multiple Sclerosis: hepatitis B infection
What Are the Symptoms of an Autoimmune Disease?
There are more than 80 types of autoimmune diseases, and some have very similar symptoms. This is what often makes it difficult for your health care provider to determine whether or not you have an autoimmune disease, and if so, which one. Waiting for a proper diagnosis can be both frustrating and stressful not only for you, but for your physician as well.
Often, the first recognizable symptoms of an autoimmune disease can be:
- Muscle aches
- Low-grade fever
- Difficulty concentrating
- Inflammation, which can cause redness, heat, pain and swelling
- Discoloration, numbness and tingling in hands and feet
- Dry eyes or mouth
- Unexplained hair loss
- Sores in the nose or mouth
- Shortness of breath or heart palpitations
- Skin rashes
- Unexplained weight loss
- Abdominal pain, blood or mucus in your stool, diarrhea or mouth ulcers
- Repeated miscarriages
Autoimmune diseases are also known to have flare-ups, when symptoms and disease activity get worse, and remissions, when symptoms get better or disappear completely. If you have a sudden onset of symptoms or worsening of severity in symptoms, it is important to contact your doctor immediately.
How Are Autoimmune Diseases Diagnosed?
As we discussed in the beginning of this blog, your immune system produces antibodies (proteins that recognize and destroy specific substances). When you have an autoimmune disease, your body produces antibodies against some of your own tissues. Diagnosing an autoimmune disease involves identifying which antibodies your body is producing.
The following tests are used to diagnose an autoimmune disease:
- Antinuclear antibody tests (ANA)—a type of autoantibody test that looks for antinuclear antibodies, which attack the nuclei of cells in your body
- Autoantibody tests—any of several tests that look for specific antibodies to your own tissues
- Complete blood count (CBC)—measures the numbers of red and white cells in your blood
- Erythrocyte sedimentation rate (ESR)—this test indirectly measures how much inflammation is in your body
*It is important to understand that there is no singular test (with a result that is either positive or negative) that can confirm or deny a diagnosis of lupus or many other autoimmune diseases. The doctor must take into account the patient’s entire medical history and all of the other signs and symptoms being experienced. For this reason, it is advisable to keep a journal of your symptoms being as detailed as possible. This is a great tool to help communicate clearly with your treating physician.
How Are Autoimmune Diseases Treated?
There is currently no cure for these chronic autoimmune conditions. Controlling the progression of the disease and decreasing the symptoms, especially during flares, are the main goals of treatment and disease management. If you have an autoimmune disease, you and your doctor will work together to create a plan to manage your symptoms.Treatment methods depend on the disease, but in most cases one important goal that is common to most autoimmune diseases is the reduction of inflammation.
Here is a list of things you might do to alleviate the symptoms of an autoimmune disease:
- Take immunosuppressive medication as prescribed by your physician
- Take anti-inflammatory medication, if joints are affected and as prescribed by your physician
- Take pain medication as prescribed by your physician
- Drink water to stay hydrated
- Eat a balanced and healthy diet
- Get regular and gentle exercise
- Make sure that you are well rested
- Take vitamin supplements (please consult your physician before taking any herbal supplements as they could interfere with the efficacy of any other prescribed medications)
- Decrease stress
- Get physical therapy as needed to improve movement and reduce joint stiffness
- Limit sun exposure for those with photosensitivity
- Learn to understand and avoid any known triggers of flare-ups (increases in disease activity)
Some have found the following alternative therapies helpful for pain relief and stress management:
- Herbal remedies (please consult your physician before taking any herbal supplements as they could interfere with the efficacy of any other prescribed medications)
- Yoga or Tai Chi
What types of doctors treat autoimmune diseases?
Although rheumatologists are the primary care physicians for those suffering with autoimmune diseases like lupus and RA, depending on the symptoms presenting, other specialists may be recommended.Regardless of how many physicians and specialists you are referred to, it is important to have one supportive and understanding main doctor to help you navigate your disease. This physician will have a holistic picture of your specific needs and assist you in coordinating care between specialists.
Here is a descriptive list of some specialists who treat autoimmune diseases and their symptoms:
- Audiologist: A health care worker who can help people with hearing problems, including inner ear damage from autoimmune diseases.
- Counselor or Psychologist: These health care workers are specially trained to help you to find ways to emotionally [cope with your illness]. You can work through your feelings of anger, fear, loss, denial, and frustration. It can be very helpful for family members and caregivers to also be able to speak with someone about their feelings as well.
- Dermatologist: A doctor who treats diseases that affect the skin, hair, and nails, such as psoriasis and skin-related lupus conditions like discoid lupus and cutaneous lupus.
- Endocrinologist: This is a doctor who treats gland and hormone problems, including diabetes and thyroid disease.
- Gastroenterologist: Problems with the digestive system, such as inflammatory bowel disease (IBS) will be treated by this type of physician.
- Hematologist: These physicians treat diseases that affect blood, such as some forms of anemia.
- Nephrologist: This type ofdoctor treats kidney problems, such as [kidney nephritis] that can be caused by lupus. Kidneys are the organs that produce urine and clean the blood.
- Neurologist: A neurologist treats nerve problems, such as multiple sclerosis and myasthenia gravis and may be seen for various degrees of cognitive dysfunction (also known as brain fog) that accompanies many autoimmune diseases.
- Occupational therapist: These specialists can teach you new ways of doing things despite your pain and health issues. They can also recommend ways to change your work or home environments to better function specifically for you your needs. This can include how to use and where to find special devices that can make the activities of daily living easier.
- Physical therapist: A trained medical provider that can recommend and teach proper exercise techniques and activities to help patients with pain, muscle weakness, and stiffness resulting in restricted body movement.
- Rheumatologist: This type of doctor who treats arthritis and other rheumatic diseases, such as scleroderma and [lupus].
- Speech therapist: A health care worker who can help people with speech problems from illness such as multiple sclerosis and other neurological issues.
- Vocational therapist: These healthcare workers provide job training for people who cannot do their current jobs because of their illness or other health problems. Both public and private agencies can help find this type of specialist.
Questions to Ask Your Doctor
- Are my symptoms a sign that I might have an autoimmune disease?
- Based on my symptoms, what kind of autoimmune disease am I likely to have?
- What tests should I have? What do they look for?
- If I have an autoimmune disease, can it be treated?
- Is there anything that can be done now to help me feel better?
There is currently no cure for most autoimmune diseases, but researchers are looking for new ways to treat them and help manage symptoms with better medications. The ultimate goal, of course, is finding a cure. Pharmaceutical medications can help manage symptoms and, in some cases, may even help slow the progress of the disease. Additionally, alternative treatments such as lifestyle changes such as introducing a healthful diet, regular exercise, rest, and stress management may be incorporated into an autoimmune disease treatment plan with great benefit.
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