March is National Autoimmune Disease Awareness Month! According to the Autoimmune Association, Autoimmunity is now one of the most common disease categories, ahead of cancer and heart disease. We thought, what better time to spotlight one of the leading types of chronic conditions affecting approximately 50 million Americans than now!
What Does “Autoimmune” Mean?
Our immune systems are our body’s natural defense system. One of its primary functions is to protect the body by going after “foreign” invaders and substances such as microorganisms, viruses or bacteria. It produces antibodies (produced by white blood cells) that communicate with each other to attack potentially harmful invaders. The problem arises when, in some instances, immune cells mistake the good cells for bad cells. In autoimmunity, it thinks normal healthy cells are a threat and goes after them as if they were foreign invaders. This can lead to the development of an auto (meaning self) immune disease.
Autoimmune diseases range in variety and severity and include a broad umbrella of related disorders where a person’s defense system (the immune system) attacks their cells and tissue by mistake.
What causes It?
Most healthy immune systems can distinguish “self” from “non-self.” Interestingly, some natural autoimmunity occurs in everyone to some degree; and in most people, it does not result in diseases. Unfortunately, various factors can lead someone to move outside of the normal immune response and develop an autoimmune disease. When this happens, the immune system can become overactive and turn on the body’s healthy tissues, resulting in various symptoms and disease manifestations.
The exact cause of autoimmune diseases is not entirely understood. Still, genetics combined with bacteria, viruses, toxins, and some drugs may trigger an autoimmune process in someone who already has the predisposition to develop one. Experts think the inflammatory response caused by these agents may provoke the body into an autoimmune reaction.
Types of Autoimmune Diseases:
There are different ways to classify autoimmune disorders. One of the most common is categorizing autoimmune diseases into organ-specific and non-organ-specific conditions (also called systemic). For example, some manifestations destroy a specific cell or tissue type and interfere with organ function. Like with autoimmune thyroid disorder, Hashimoto's disease (one type of autoimmune thyroid disease) where immune-system cells lead to the death of the thyroid's hormone-producing cells. Other autoimmune diseases like Type-1 Diabetes (pancreas), Addison’s disease (adrenal glands), or vitiligo (pigment producing skin cells) can all affect mainly one organ in the body.
In non-organ-specific disorders, the autoimmune process is widely spread throughout the body. Like in lupus, joints, skin, cardiovascular system, kidneys, lungs, brain, and many other organs can be affected. Other diseases like rheumatoid arthritis, dermatomyositis, and scleroderma can affect the body systemically too.
Who are most affected:
Autoimmune diseases can affect anyone. However, women seem to be the most susceptible. It can also vary by race. For example, African American women are three times more likely to get the disease lupus. Lupus is also more common in Hispanic, Asian, Native American, and Alaskan Native women. Fibromyalgia, a disease that is more than twice as likely to affect women than men, is now being looked at as a possible autoimmune disorder as well.
The question is, why?
Could it be in women that the significant number of genes originating from the X chromosome creates a greater possibility of more extensive mutations? One cause is related to the numerous genes on the X chromosome that are related to many of these diseases that occur more commonly in women. This puts women at a greater risk for developing autoimmune diseases solely due to women having two X chromosomes, whereas men possess only one. Another possibility is that autoimmune diseases tend to affect women during major endocrine transitions, such as puberty, pregnancy, and menopause. These changes may significantly impact the immune system because of the interaction between hormones, the immune system, and other organs in the body. Since women experience more hormonal changes than men, this may be another theory that autoimmune diseases are more prevalent in women. Additionally, women typically mount a more vigorous immune response than men to infections and vaccinations (which leads to men having more infectious diseases than women…at least we have that going for us), producing higher levels of antibodies. In the case of autoimmune disorders, this trait seems to backfire.
But let's be clear, men can and DO develop autoimmune disorders. Unfortunately, like in the case of lupus, it can be quite complicated and involved. Sadly, several research studies have suggested men often experience a more severe form of the disease and are dismissed or dismiss their symptoms themselves because of stigma's attached to many autoimmune conditions.
Treatment Options:
If this is the response, how do you treat it? Or, at the very least, how do you manage it? Unfortunately, there is no cure for most autoimmune diseases, but symptoms CAN be managed. Because of every person's immune system, genetics, and environment are different; treatments may be different and unique for each person's autoimmune disease.
Here are some examples of medications used to treat autoimmune diseases:
Corticosteroids.
Anti-inflammatories.
Pain medications.
Medications for depression and anxiety.
Insulin injections.
Sleeping medications.
Plasma exchanges.
Intravenous immune globulin.
Drugs that suppress (subdue) the immune system.
Consider these things below (adapted from the "Lupus Secret's from www.lupusencyclopedia.com) which are very important to do if living with an autoimmune disease:
Get 8 or more hours of good quality sleep each night: If having trouble, do everything in the Sleep Hygiene handout
Do not smoke cigarettes.
Maintain normal body weight.
Take a vitamin D supplement if your level is less than 40 ng/mL
Use sunscreen every day, and abide by ultraviolet light protection (see UV Protection Handout)
Eat a healthy diet.
Work on decreasing stress (see Stress Reduction handout)
Take your medication as prescribed!
What Kind of Doctor Treats Autoimmune Diseases?
The specialist you need depends on the type of autoimmune disease you have. Your healthcare provider may refer you to one of these below:
Rheumatologist.
Gastroenterologist.
Endocrinologist.
Dermatologist.
If you are seeing a rheumatologist for the first time, consider reading our blog on how to have a successful visit.
Research:
For the latest research on autoimmune disorders, check out the latest research initiatives from the Autoimmune Association here!
Closing thoughts from an autoimmune patient:
Living with an autoimmune disorder can be a lot to manage. Having an overactive immune system is, to put it mildly, tricky. Often, your defense system is so busy attacking your own cells by mistake that it doesn't adequately protect you from the actual threats that enter your body. Add in immunosuppressive therapy, and you can feel like a sitting duck waiting to get pounced on by the latest virus.
That is why living through the global pandemic has been so challenging for those of us with not just one but multiple autoimmune disorders. We are forgotten and, may I say, forsaken.
A few months ago, I was leaving the store, and a person yelled out across the parking lot, "You don't have to wear a mask, YOU KNOW!" The mere visual of my mask triggered anger, insecurity, and fragility in this person. I didn't have the energy to explain that I had come from a 2-and-a-half-hour immunosuppressive therapy infusion. Nor did I think that I had to defend myself. I can't defend myself literally...I have an autoimmune disease. For me, a cold can become pneumonia and UTI can turn into sepsis. Everything is an increased risk, and the most basic, simple, and effective way to protect myself is to wear a mask and wash my hands. If that is offensive to someone; that has more to do with their heart than my immune system.
Written By:
Kelli (Casas) Roseta
Medically Reviewed and Edited by:
Donald Thomas, MD, FACP, FACR, RhMSUS
Sources:
The Lupus Encyclopedia, By Donald E. Thomas, Jr. M.D., FACP, FACR, Johns Hopkins Press, p. 9-11
Meghan O’Rourke, The Invisible Kingdom, 2022, p. 104-105, 106-107; 261 Riverhead Books
March 2023
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