What Is Autoimmunity?
When your
body is attacked--perhaps by a virus or germs on a nail you
stepped on--your immune system defends you. It sees and kills the
germs that might hurt you.
But when the
system doesn't work right, this process can cause harm. Immune
cells can mistake your body's own cells as invaders and attack
them. This "friendly fire" can affect almost any part of the body.
It can sometimes affect many parts of the body at once. This is
called autoimmunity (meaning self-immunity).
What Causes Autoimmunity?
No one knows
why the immune system treats some body parts like germs. We do
know that you can't catch autoimmune diseases from another person.
Most
scientists think that our genes and things in the environment are
involved. If you have a certain gene or combination of genes, you
may be at higher risk for autoimmune disease. But you won't get
the disease until something around you turns on your immune
system. This may include the sun, infections, drugs, or, in some
women, pregnancy.
What
Kinds of Problems Are Caused by Autoimmunity?
Autoimmunity
can affect almost any organ or body system. The exact problem one
has with autoimmunity (or its diseases) depends on which tissues
are targeted.
If the skin
is the target, you may have skin rashes, blisters, or color
changes. If it's the thyroid gland, you may be tired, gain weight,
be more sensitive to cold, and have muscle aches. If it's the
joints, you may have joint pain, stiffness, and loss of function.
You may know
which organ or system is affected from the start. But you may not
know the site of the attack. In many people, the first symptoms
are fatigue, muscle aches, and low fever.
Where Does Autoimmunity
Strike?
Because
autoimmune diseases can affect almost any organ or system of the
body, one way to group them is by the body system(s) they attack.
The following is a list (not inclusive) of body systems and the
autoimmune diseases that can affect them.
Digestive tract (including the
mouth)
- Autoimmune hepatitis
- Behçet's disease
- Crohn's disease
- Primary bilary
cirrhosis
- Scleroderma
- Ulcerative colitis
How Are Autoimmune
Diseases Diagnosed?
Autoimmune
diseases often don't show a clear pattern of symptoms at first. So
diagnosing them can be hard. But with time, a diagnosis can
usually be made by using:
- Medical history--The
doctor will ask about your symptoms and how long you have had
them. Your symptoms may not point to one disease. But they can
be a starting point for your doctor. You should tell your doctor
if you have a family member with autoimmune disease. You may not
have the same disease as your family member. But having a family
history of any autoimmune disease makes you more likely to have
one.
- Physical exam--During
the exam, the doctor will check for any signs. Inflamed joints,
swollen lymph nodes, or discolored skin might give clues.
- Medical tests--No
one test will show that you have an autoimmune disease. But
doctors may find clues in a blood sample. For example, people
with lupus or rheumatoid arthritis often have certain
autoantibodies in their blood. Autoantibodies are blood proteins
formed against the body's own parts.
Not all people with
these diseases have these autoantibodies. And some people
without autoimmune disease do have them. So blood tests alone
may not always help. But if a person has disease symptoms and
autoantibodies, the doctor can be more sure of a diagnosis.
The key is
patience. Your doctor may be able to diagnose your condition
quickly based on your history, exam, and test results. But the
process often takes time. It may take several visits to find out
exactly what's wrong and the best way to treat it.
How Are Autoimmune
Diseases Treated?
Autoimmunity
takes many forms. There are also many treatments for it. Treatment
depends on the type of disease, how severe it is, and its
symptoms. Generally, treatments have one of three goals:
- Relieving symptoms--If
your symptoms bother you, your doctor may suggest treatments
that give some relief. Relieving symptoms may be as simple as
taking a drug for pain relief. It may also be as involved as
having surgery.
- Preserving organ
function--When autoimmune diseases threaten organs,
treatment may be needed to prevent damage. Such treatments may
include drugs to control an inflamed kidney in people with
lupus. Insulin injections can regulate blood sugar in people
with diabetes. These treatments don't stop the disease. But they
can save organ function. They can also help people live with
disease complications.
- Targeting disease
mechanisms--Some drugs may also be used to target how the
disease works. In other words, they can suppress the immune
system. These drugs include cyclophosphamide (Cytoxan*) and
cyclosporine (Neoral and Sandimmune). The same
immune-suppressing drug may be used for many diseases.
Your doctor
may not prescribe a treatment. If your symptoms are mild, the
risks of treatment may be worse than the symptoms. You may choose
to put off treatment for now. But you should watch for signs that
your disease is progressing. Visit your doctor regularly. You need
to catch changes before they lead to serious damage.
What
Types of Doctors Treat Autoimmune Diseases?
Treatments
for autoimmune diseases vary. So do the types of doctors who
provide them.
For some
people, one doctor will be enough to manage their disease. Others
may require a team approach. One doctor might coordinate and give
care, and others would treat specific organ problems. For example,
a person with lupus might be seen by a rheumatologist. But that
person might also see a nephrologist for related kidney problems
and a dermatologist for skin problems.
Specialists
you may need to see include:
- A rheumatologist, who
treats arthritis and other rheumatic diseases. These include
scleroderma and systemic lupus erythematosus (lupus or SLE).
- An endocrinologist,
who treats gland and hormone problems. These include diabetes
and thyroid disease.
- A neurologist, who
treats nerve problems. These include multiple sclerosis and
myasthenia gravis.
- A hematologist, who
treats diseases that affect the blood. These include pernicious
anemia and autoimmune hemolytic anemia.
- A gastroenterologist,
who treats problems with the digestive system. These include
Crohn's disease and ulcerative colitis.
- A dermatologist, who
treats problems of the skin, hair, and nails. These include
psoriasis, pemphigus/pemphigoid, and alopecia areata.
- A nephrologist, who
treats kidney problems. These include glomerulonephritis,
inflamed kidneys associated with lupus.
What Are Some Other Problems Related to Autoimmune Diseases?
Having a
chronic disease can affect almost every part of your life. The
problems you might have with an autoimmune disease vary. They may
include:
- How you look and
your self-esteem--Depending on your disease, you may have
discolored or damaged skin or hair loss. Your joints may look
different. These can all affect how you look and your
self-esteem. Such problems can't always be prevented. But their
effects can be reduced with treatment. Cosmetics, for example,
can hide a skin rash. Surgery can correct a malformed joint.
- Caring for yourself--Painful
joints or weak muscles can make it hard to do simple tasks. You
may have trouble climbing stairs, making your bed, or brushing
your hair. If doing daily tasks is hard, talk with a physical
therapist. The therapist can teach you exercises to improve
strength and function. An occupational therapist can show you
new ways to do things or tools to make tasks easier. Sometimes
regular exercise or simple devices can help you do more things
on your own.
- Family
relationships--Family members may not understand why you
don't have energy to do things you used to do. They may even
think you are just being lazy. But they may also be overly
concerned and eager to help you. They may not let you do the
things you can do. They may even give up their own interests to
be with you. Learn as much as you can about your disease. Share
what you learn with your family. Involve them in counseling or a
support group. It may help them better understand the disease
and how they can help.
- Sexual relations--Sexual
relationships can also be affected. For men, diseases that
affect blood vessels can lead to problems with erection. In
women, damage to glands that produce moisture can lead to
vaginal dryness. This makes intercourse painful. In both men and
women, pain, weakness, or stiff joints may make it hard for them
to move the way they once did. They may not be sure about how
they look. Or they may be afraid that their partner will no
longer find them attractive. With communication, good medical
care, and perhaps counseling, many of these issues can be
overcome or at least worked around.
- Pregnancy and
childbearing--In the past, women with some autoimmune
diseases were told not to have children. But better treatments
and understanding have changed that advice. Autoimmune diseases
can affect pregnancy, and pregnancy can affect autoimmune
diseases. But women with many such diseases can safely have
children. How a pregnancy turns out can vary by disease and
disease severity. If you have an autoimmune disease, you should
consult your doctor about having children.
What Research Is Being Conducted To Help People With Autoimmune
Diseases?
The National
Institutes of Health (NIH) supports research in autoimmune
diseases. Here are a few examples:
- Rheumatoid
arthritis--The National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) and the North American
Rheumatoid Arthritis Consortium will study 1,000 siblings with
rheumatoid arthritis. Scientists will look at gene material to
find and identify parts of DNA involved in the disease. They
will test for proteins called rheumatoid factor in the blood.
And they will look at x rays of the joints. This work will
provide basic facts about the genetics of the disease.
- Systemic lupus
erythematosus (SLE)--NIAMS-supported scientists are studying
whether women with lupus can safely take oral contraceptives or
hormone replacement therapy. Previous research suggests that
female hormones may contribute to the disease or make it worse.
- Lupus nephritis--One
NIAMS project is testing a drug that may be less toxic than the
drugs now used for lupus nephritis (kidney disease caused by
lupus).
- Vitiligo--With
NIAMS support, scientists are studying genes from pairs of
siblings affected by this skin pigmentation disorder. They hope
to find genes that may cause vitiligo and learn how they affect
the skin.
- Type 1 diabetes--Researchers
supported by the National Institute of Diabetes and Digestive
and Kidney Diseases have found a way to identify people who are
likely to get type 1 diabetes (formerly known as juvenile
diabetes). They are now testing ways to prevent these people
from getting the disease.
- Multiple sclerosis--Scientists
supported by the National Institute of Neurological Disorders
and Stroke are looking at the autoimmune system, infectious
agents, and genes as culprits in multiple sclerosis (MS). Such
studies strengthen the theory that MS comes from a number of
factors rather than a single one. Studies use magnetic resonance
imaging to see how MS lesions evolve in the brain's white
matter. Research has shown that MS has no bad effects on
pregnancy, labor, or delivery. In fact, the stabilizing or
remission of symptoms during pregnancy may be due to changes in
a woman's immune system that allow her to carry a baby.
- Multiple autoimmune
diseases--The National Institute of Allergy and Infectious
Diseases is supporting clinical trials of drugs that prevent the
immune system from attacking healthy cells. The Institute wants
to see if they are safe and useful. Such drugs may prove helpful
for treating a number of autoimmune diseases.
