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When the body attacks itself

Tuesday, September 04, 2018

There are many triggers for autoimmune disease, including stress, diet, and lack of exercise, insufficient sleep and smoking, says Dr Dipti Patel

An autoimmune disease is a condition in which your immune system mistakenly attacks your body. Our immune system is responsible for guarding us against germs like bacteria and viruses. When it senses these foreign invaders, it sends out an army of fighter cells to attack them.

In an autoimmune disease, the immune system makes a mistake and attacks the healthy cells and tissue of the body. Some autoimmune diseases target one organ and other diseases, like lupus, affect the whole body.

There are more than 80 types of autoimmune diseases. In Rheumatology the common autoimmune diseases we treat are Rheumatoid Arthritis, Systemic Lupus Erythematosus (SLE) and subsets of Lupus, Sjogrens syndrome, Systemic Sclerosis (scleroderma), Polymyositis, Dermatomyositis, Vasculitis and connective tissue diseases.

A review of literature concluded that worldwide rates of Rheumatic, endocrinological, gastrointestinal, and neurological autoimmune diseases are increasing by four to seven percent per year. However it could also be a combination of the fact that doctors are more educated on the symptoms and signs of autoimmune diseases and therefore able to diagnose patients more effectively. We also have more sensitive lab tests that detect specific autoimmune conditions early.

There are so many triggers for autoimmune disease, including stress, diet, and lack of exercise, insufficient sleep and smoking. Anything that causes chronic inflammation in the body can eventually lead to the development of an autoimmune disease, which could be one reason they are becoming increasingly common.

Causes
The exact cause of autoimmune disorders is unknown. One theory is that some micro-organism such as bacteria or viruses or drugs may trigger changes that confuse the immune system.

Some people are at a greater risk of getting autoimmune disorders. These include women of child-bearing age. In general most autoimmune disorders affect women more commonly than men; for example, in lupus, the ratio of women to men is nine to one, or 90%.

Genetics also plays an important role in developing these diseases so those who have a family history of the condition are more likely to get the disease—for example, in conditions like Rheumatoid arthritis or lupus where more than one family member can be affected.

Some races and ethnicities also have a greater risk. Lupus is more common and severe in Asian and African-Americans than in Caucasians.

Since there are so many different autoimmune diseases—all affecting different parts of the body with varying symptomatic consequences—each specific disease comes with its own unique symptoms.

Rheumatoid arthritis Immune system attacks the joints, causing inflammation, swelling and pain.

Lupus The immune system attacks various tissues within the body, commonly affecting the joints, lungs, blood cells, nerves and kidneys. The common signs and symptoms of lupus are:

  •     Joint pain, swelling and stiffness (especially small joints of hands and feet);
  •     Fatigue, low grade fevers (sometimes high fever), loss of appetite, weight loss;
  •     Rashes, which characteristically involve the shawl area and backs of the upper arms, the finger pulps, and the base of nails, as well as facial rash, often in response to sunlight (butterfly-shaped rash on face);
  •     Hair loss is common;
  •     Sores in mouth and nose.

Sjogrens Dryness of eyes, mouth, joint aches and pains, tiredness.

Polymyositis muscle pain, weakness, tiredness.

Treatment
There are different treatment options available depending on the disease. The treatment is usually to control the over- active immune response and bring down inflammation.

The drugs used to treat these conditions in Rheumatology include:
1.  Non-steroidal anti inflammatory drugs and steroids to initially give relief from pain and inflammation.

2.  Immune-suppressive drugs are specifically used to control the immune system and prevent damage to organs of the body caused by active disease inflammation. These include drugs like methotrexate, leflunomide, sulfasalazine, azathioprine and mycophenolate.

3. Biologic drugs or anti TNF agents—these are modern medicines that are available as injections to control diseases which are severe.

4.     There are several lifestyle changes which can be adapted along with treatment of autoimmune diseases which help. These include eating a healthy and balanced diet, getting regular physical exercise, maintaining healthy weight, getting adequate rest and reducing stress.

Identifying the problem
Autoimmune diseases are difficult to identify as the symptoms can vary and be vague—tiredness and fatigue with aches and pains, for instance. Most can be diagnosed with a detailed history and physical examination by a specialist and requesting blood tests looking for the presence of specific antibodies.

An ANA (antinuclear antibody) test, which can strongly indicate whether it’s an autoimmune disease or something else, is requested. CRP (c-reactive protein) and/or a ESR (erythrocyte sedimentation rate) test, both of which can detect inflammation within the body, anti ccp antibodies to detect Rheumatoid arthritis. This can be requested by the specialist depending upon the clinical suspicion of the disease.

Advice
Autoimmune diseases like rheumatoid arthritis and lupus can affect any age group and is common in a young age group between 20-40 years of age.
If you have any symptoms of joint pains, especially small joints such as the hands and feet, lasting for more than a month accompanied with symptoms of swelling, early morning stiffness lasting for more than one hour, pain on squeezing the joints and other symptoms of skin rash, tiredness and weight loss, then it is best to get an appointment with a Rheumatologist to identify the exact cause of the symptoms and exclude any autoimmune condition. Do not ignore symptoms of joint pains; connect with a Rheumatologist.

Dr Dipti Patel, Rheumatologist Consultant, Wockhardt Hospital Mumbai Central

Short Takes

  •     In an autoimmune disease, the immune system makes a mistake and attacks the healthy cells and tissue of the body.
     
  •     Some autoimmune diseases target one organ and other diseases, like lupus, affect the whole body.

CASE STUDIES

  1. A 26-year-old girl presented with a one-year history of joint pains affecting her hands, feet and knees, with swelling and stiffness in the morning. She tried a variety of pain relief and alternative medicines for a year and reached a stage where she had to quit her job and was not able to walk. She was seen in a Rheumatology clinic and a diagnosis of Rheumatoid arthritis was made based on her history, examination and blood results. She commenced modern immune-suppressive treatments and is now, after three months of treatment, completely well and active. She can lead a completely normal life by continuing the treatment long term.
     
  2.  A 30-year female presented with joint pains, tiredness, severe mouth ulcers and skin rash on the face and chest wall. A diagnosis of lupus was made based on the presentation and blood tests and appropriate treatment commenced. She will now see a rheumatologist regularly to ensure her kidneys are not affected. Early diagnosis and treatment can prevent future complications.
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