A. What are Autoimmune Disorders?
An autoimmune disorder is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. There are more than 80 different types of autoimmune disorders.
B.Causes of Autoimmune Disorders
The cause of autoimmune diseases is unknown, but it appears that there is an inherited predisposition to develop autoimmune disease in many cases. In a few types of autoimmune disease (such as rheumatic fever), a bacteria or virus triggers an immune response, and the antibodies or T-cells attack normal cells because they have some part of their structure that resembles a part of the structure of the infecting germ.
Normally the immune system's army of white blood cells helps protect the body from harmful substances, called antigens. Examples of antigens include bacteria, viruses, toxins, cancer cells, and foreign blood or tissues from another person or species. The immune system produces antibodies that destroy these harmful substances.
But in patients with an autoimmune disorder, the immune system can't tell the difference between healthy body tissue and antigens. The result is an immune response that destroys normal body tissues. The response is a hypersensitivity reaction similar to allergies, where the immune system reacts to a substance that it normally would ignore. In allergies, the immune system reacts to an external substance that would normally be harmless. With autoimmune disorders, the immune system reacts to normal body tissues.
What causes the immune system to no longer distinguish between healthy body tissues and antigens is unknown. One theory holds that various microorganisms and drugs may trigger some of these changes, particularly in persons who are genetically prone to autoimmune disorders.
Autoimmune disorders fall into two general types:- Systemic Autoimmune Disease: those that damage many organs, include: rheumatoid arthritis (joints; less commonly lung, skin), lupus [Systemic Lupus Erythematosus] (skin, joints, kidneys, heart, brain, red blood cells, other), Scleroderma (skin, intestine, less commonly lung), Sjogren's syndrome (salivary glands, tear glands, joints), Goodpasture's syndrome (lungs, kidneys), Wegener's granulomatosis (sinuses, lungs, kidneys), Polymyalgia Rheumatica (large muscle groups), Temporal Arthritis / Giant Cell Arthritis (arteries of the head and neck).
- Localized Autoimmune Disease: those where only a single organ or tissue is directly damaged by the autoimmune process, include: Type 1 Diabetes Mellitus, Hashimoto's thyroiditis, Graves' disease (thyroid),celiac disease, chron's disease, ulcerative colitis, Multiple sclerosis*, Guillain-Barre syndrome (central nervous system), Addison's disease (adrenal), Primary biliary sclerosis, Sclerosing cholangitis, Autoimmune hepatitis (liver), Raynaud’s phenomenon (fingers, toes, nose, ears)
- The destruction of one or more types of body tissue
- Abnormal growth of an organ
- Changes in organ function
An autoimmune disorder may affect one or more organ or tissue types. Organs and tissues commonly affected by autoimmune disorders include:
- Red blood cells
- Blood vessels
- Connective tissues
- Endocrine glands such as the thyroid or pancreas
- Muscles
- Joints
- Skin
Symptoms of an autoimmune disease vary widely and depend on the specific disease. A group of very nonspecific symptoms often accompany autoimmune diseases, and may include:
- Dizzines
- Fatigue
- General ill-feeling
- Low-grade fever
The health care provider will perform a physical exam. Specific signs vary widely and depend on the specific disease.
Tests that may be done to diagnose an autoimmune disorder may include:
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
The goals of treatment are to reduce symptoms and control the autoimmune process while maintaining the body's ability to fight disease. Treatments vary widely and depend on the specific disease and your symptoms.
Some patients may need supplements to replenish a hormone or vitamin that the body is lacking. Examples include thyroid supplements, vitamins, or insulin injections.
If the autoimmune disorder affects the blood, the person may need blood transfusions.
Measures to help with movement or other functions may be needed for autoimmune disorders that affect the bones, joints, or muscles.
Medicines are often prescribed to control or reduce the immune system's response. Such medicines may include corticosteroids and immunosuppressant drugs such as cyclophosphamide or azathioprine.
The treatment for autoimmune disorders is similar to the treatment for multiple chemical sensitivities, i.e., identifying and unlearning the specific allergic reactions, detoxification, and supporting adrenal and immune system function. However, the parts of your body that have been impacted by an autoimmune reaction, glands, organs, joints, even the nervous system, may also need attention. These will begin to heal themselves after the autoimmune reaction is cleared, but may also need healing, supplements or more conventional rehabilitation practices. Furthermore, in the cases where joint, organ, glandular, neural structures have been significantly impaired, major medical intervention and support is indicated, e.g., insulin or knee replacement.
Outlook (Prognosis)
The outcome depends on the specific disease. Most are chronic, but many can be controlled with treatment. Symptoms of autoimmune disorders can come and go. The sudden, severe development of symptoms is called a flare up.
Traits in Common
That such different-seeming diseases as psoriasis and diabetes could stem from a common cause actually is a relatively new notion, according to Noel R. Rose, MD, PhD, professor of molecular microbiology and immunology and pathology at the Johns Hopkins University in Baltimore. Back in the early days of the last century, he says, the idea took hold that if the immune system were to benefit us, it would have to be warding off foreign invaders from outside the body.
Now, scientists know that the immune system is a set of actions and reactions that can be triggered by a number of things besides an invading germ, virus, or bacteria. One thing that puts you at risk for being attacked by your own immune system is your genetics, says Rose. In other words, if your parents have a predisposition to autoimmune disease, you may, too. "And it's an overlapping inheritance," Rose says. "If you have one autoimmune disease, you may have more -- and you may have different ones than your parent did (or your siblings do)."
Another common characteristic of all autoimmune diseases is that it is thought that an 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 to set it off. Examples of these are infections, certain foods (iodine or gluten products), and toxins (some drugs, smoking, certain hair dyes, chemicals in the workplace).
Dozens of culprits have been identified. Shomon reels off a list of possible suspects in the more common autoimmune ailments: hair dye and certain drugs for lupus, silica exposure for scleroderma; gluten for diabetes; mycoplasmas for rheumatoid arthritis; measles virus for Epstein-Barr; coxsackie virus for diabetes; smoking for thyroid, lupus, and arthritis; hepatitis B infection for multiple sclerosis. She says physical trauma can also touch off the immune response.
As the disease develops -- or more than one, as Rose points out -- vague symptoms start to appear, such as joint and muscle pain (very common), general muscle weakness, possible rashes or low-grade fever, trouble concentrating, or weight loss. More specific signs can point toward something being wrong: numbness and tingling in hands and feet (also common), dry eyes (common), hair loss, shortness of breath, heart palpitations, or repeated miscarriages can also be caused by an autoimmune response.
Research Continues
Although autoimmune disorders can make life miserable, they usually are chronic and not fatal, Shomon says. Most are handled by a range of doctors from internist to rheumatologist to dermatologist. "There is no such thing as an autoimmunologist," she says. Usually, it's the researchers that are seeking to attack the disorders as a common group.
According to Rose, some approaches being tried include a complete "reboot" of the immune system -- the famous bone marrow transplant. "This is only tried if other treatments have failed," he says. "The idea is that if the entire immune system is erased, it might to a better job the second time around." Doctors at Johns Hopkins use a chemotherapy drug called cyclophosphamide to "reboot" the immune system. This has showed promise in a number of lupus patients.
If the causative agent of the disease is known, a vaccine can be developed. Immunoglobulin or antibodies are being used in children with the heart disease called Kawasaki disease, as well as Guillain-Barre and multiple sclerosis.
What You Can Do Now
If you suspect you may have an autoimmune problem, it's very important to identify and deal with any food allergies, according to Shomon. The main offenders are wheat, diary, corn, soy, fish (especially shellfish), nuts, and fruits. High sugar, she contends, stresses the immune system. Make sure you eliminate trans fats and other bad fats and get enough good fats such as olive oil, fish oil, and avocado.
You also want to minimize infections -- wash your hands frequently. Take care of your teeth for the same reason: Gum diseases leak triggers into the body. Some people even lavage their noses with warm salt water to remove possible troublemakers.
Each autoimmune disorder also will have separate dietary and therapeutic recommendations. It's important to follow your doctor's orders. This is not a quick fix -- it's a lifestyle.
SOURCES:
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Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Mary J. Shomon, author, Living Well With Autoimmune Disease. Noel R. Rose, MD, PhD, professor of molecular microbiology and immunology and pathology, Johns Hopkins University, Baltimore.
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