Posted on: January 26, 2016
THE MYSTERY OF AUTOIMMUNE DISORDERS
By Dr. Ronen Marmur
Without your immune system, your body would be open to infection from viruses and bacteria.
But this helpful ally can sometimes turn on you and mistakenly attack joints, muscles, and even organs. Because no one is sure what triggers autoimmune disorders, diagnosing and treating the problems can be puzzling for patients and doctors. Recognizing some of the potential risks and symptoms can help you get the care you need.
Early diagnosis is crucial to successfully managing autoimmune disorders.
Symptoms can be vague and the cause can be unclear. Patients should talk to their doctor if they have unexplained:
• muscle weakness
• joint pain
• swelling or inflammation
Sometimes people will have breathing troubles, swollen lymph nodes, or digestive problems such as diarrhea.
There are more than 80 different types of autoimmune disorders and they affect between 5% and 8% of Americans, according the National Institutes of Health. About 80% of those afflicted are female—women of African-American, Native-American, and Hispanic descent have the highest risk.
One of the more common autoimmune targets is the thyroid gland. In Graves disease, an overactive thyroid gland can make patients restless, unable to sleep, irritable, and anxious. Hashimoto’s disease is the opposite: It slows down the thyroid gland and can cause weight gain, depression, and low energy. Other common autoimmune diseases include rheumatoid arthritis (joints), lupus (organs and joints), multiple sclerosis (nerves), and Type 1 diabetes.
Why are women more susceptible? No one’s really sure, but hormone changes may play a role. Autoimmune diseases are often diagnosed in women of child-bearing age or during menopause. Other risk factors include a family history of autoimmune troubles, exposure to certain chemicals such as solvents, some viral or bacterial infections, and even dental issues like gingivitis. The Epstein-Barr virus can trigger lupus, for example.
The first stop for patients is their primary care physician, where the doctor can go over the symptoms and see if the patient needs to see an autoimmune specialist—which type will depend on your symptoms. A rheumatologist such as myself focuses on arthritis, lupus, and certain autoimmune skin conditions; a neurologist can help diagnose multiple sclerosis; an endocrinologist can help manage thyroid problems or diabetes.
To help with the diagnosis, patients should keep a diary of symptoms and a detailed family health history. Your specialist will run blood tests and do imaging to try and identify autoimmune disorders while ruling out other potential causes of the symptoms. For example, chronic fatigue syndrome and fibromyalgia are not autoimmune problems, even though they have similar symptoms. The patient should be aware that testing doesn’t always lead to diagnosis.
There are two major categories of treatments: Disease modifiers, which can prevent and in some cases reverse the damage caused by the disorder; and symptom relievers—medications that help manage the pain and associated problems with the disease. Some autoimmune disorders can be treated and controlled. With an early diagnosis, rheumatoid arthritis can go into remission, though medications alone won’t solve all the problems. Patients can still have pain and fatigue even if their rheumatoid arthritis is completely suppressed. That’s where the second group of symptom-relieving medications can play a role.
By sticking to the treatment plan, eating healthy, and staying active, patients can help keep their symptoms under control and slow the progression of their disease.
Early diagnosis is crucial to successfully managing autoimmune disorders. The research shows that late diagnosis and treatment leads to much worse outcomes—especially for rheumatoid arthritis and lupus. This is true for many autoimmune disorders, such as Type 1 diabetes, inflammatory bowel disease (Crohn’s or colitis), and celiac disease: The sooner patients can get treatment and alter their diet (removing gluten in the case of celiac), the better off they’ll be. Alternative therapies can sometimes help alleviate the pain, but they rarely help as a primary treatment. Once you start medical treatment, alternative therapies such as stress management, massage, physical activity, and altering diet may bring additional relief—just make sure to check with your doctor and keep him or her informed.
Currently there are no cures for autoimmune diseases but, depending on the condition, patients can minimize the impact on their lives. Treatments can bring about homeostasis—we can keep certain diseases from progressing. By sticking to the treatment plan, eating healthy, and staying active, patients can help keep their symptoms under control and slow the progression of their disease.
Ronen Marmur, MD/PhD is a rheumatologist at Mount Kisco Medical Group and Northern Westchester Hospital. You can learn a lot more about autoimmune disorders at the website for the American Autoimmune Related Diseases Association: www.aarda.org.