Know about the connection between autoimmune disease and rheumatology

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

An elderly hand with Rheumatoid Arthritis

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.

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 4 to 7 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 microorganism 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 then men for example lupus in which the ratio women to men is 9 to 1 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 1 family member can be affected.

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

Because 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: 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

Sjögren’s syndrome: 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:-

Non-steroidal anti-inflammatory drugs (NSAIDs) and steroids to initially give relief form pain and inflammation

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, mycophenolate etc.

Biologic drugs or anti TNF agents: These are modern medicines which are available as injections to control diseases which are severe.

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

The author is a Rheumatologist Consultant at Wockhardt Hospital, Mumbai Central