There are more than eighty different types of autoimmune diseases. Some of these diseases can have symptoms that, if not treated, can cause much suffering and even death.
What is an autoimmune disease?
Our immune system helps to fight infections from viruses and bacteria – but sometimes it can turn on itself by mistake. An autoimmune disease occurs when the immune system attacks a person’s own cells and tissues. This can happen in almost any part of the body, from the brain to muscles, skin, and other organs. Recent studies have shown that the number of people with one of these conditions has been increasing in the last several decades.
Who gets an autoimmune disease?
An autoimmune disease can affect any one, but about 80 percent of people with autoimmune conditions are women, with some diseases, like Sjogren’s syndrome, having a women-to-men ratio as high as 9:1. Most studies suggest that these conditions tend to develop during the childbearing years. Females have a higher susceptibility to autoimmune diseases than men – in fact, autoimmune diseases as a group rank among the leading 10 causes of death for women. For many years it was assumed that hormones such as oestrogen were involved but, more recently, it has been suggested that genetic factors linked to the X chromosome may be involved. As females have two X chromosomes, while men only have one, the second may give an extra ‘dose’ of X that may make women more susceptible to X-linked conditions. A recent study from the University of Michigan showed how different genetic expressions in women could increase their chances of autoimmune-related diseases. In addition, females and males often differ in their susceptibility to the effects of environmental agents that might impact autoimmunity. Despite this, the reason for the sex disparity remains a mystery.
The rapid increase suggests that environmental factors play a role in the increasing incidence of autoimmune diseases – a notion also supported by the fact that the increase in incidence of autoimmune disease is evident in recent migrants to western countries. Environmental risk factors range from ultraviolet radiation and asbestos to solvents in cleaning products and nail polish. Silica dust [from working with quartz, granite and other minerals] and smoking are two risk factors for autoimmune disease. Mercury is another toxicant that has been suggested to play a role in autoimmunity. A study from the University of Michigan found that mercury from eating large fish like swordfish, and to lesser amounts of tuna, salmon, and other seafood, correlated with higher autoimmunity – even at levels considered safe.
We do not yet fully understand why autoimmune diseases develop.
Common autoimmune diseases
There are many autoimmune diseases, but here are a few you should know about. Recently there has been much publicity regarding lupus. This disease causes inflammation in many different parts of the body, including the joints, skin, kidneys, brain, blood vessels, heart, and lungs. The symptoms of lupus can mimic other diseases and all symptoms are not always present, making lupus hard to diagnose. Common signs are a butterfly-shaped rash across the cheeks and nose, joint pain, fatigue, skin lesions, and headaches. As lupus affects major organs, it can have life-threatening effects if not controlled with medications such as corticosteroids or immunosuppressants.
Rheumatoid arthritis
Rheumatoid arthritis (RA) affects many young people and is caused by inflammation in the joints, not wear and tear like older people’s arthritis. With RA, your body attacks its own healthy joint tissue. Symptoms include joint pain, stiffness, and swelling, most commonly in the small joints of the hands and feet. Although it is not the debilitating condition it once was, medications are necessary to slow the progression of this incurable disease. These might include ‘disease-modifying antirheumatic drugs’ like methotrexate. Low-impact exercise is also very important to increase muscle strength and reduce pressure on your joints. A new study from the U.K. showed that those who got treatment within six months of the onset of symptoms had very good long-term outcomes.
Hashimoto’s thyroiditis
In this autoimmune condition, the body attacks the thyroid gland causing it to become underactive (hypothyroidism). As with other autoimmune-related diseases, Hashimoto’s symptoms may come on gradually and be very non-specific. They include fatigue, weight gain, constipation, sensitivity to cold, dry skin, depression, and muscle aches. You may also develop a swelling, called a goitre, in the thyroid, located at the front of the neck. Luckily, a blood test can detect if your levels are low, and thyroid hormone replacement medications are very effective and have few side effects. Another thyroid-related autoimmune condition is Graves’ disease which causes your thyroid to be overactive (hyperthyroid).
Celiac disease
The trigger for celiac disease is clear. When you eat gluten (found in wheat, rye, and barley) the body attacks the small intestine causing long-term damage that could prevent the absorption of nutrients. According to the Celiac Disease Foundation, it is also genetic, so having an immediate family member with it – gives you a 1 in 10 chance of developing the condition yourself. Although adults might have digestive symptoms including diarrhea, abdominal pain, and bloating, more than half do not. Instead, symptoms may include anaemia, fatigue, bone or joint pain, depression, or skin rash. Treatment is a gluten-free diet, and since there are so many hidden places to find gluten (including non-foods like vitamins, lipstick, and toothpaste), it is important to work with a dietitian to help you.
Another bowel-related autoimmune condition is inflammatory bowel disease which includes Crohn’s and ulcerative colitis.
Psoriasis
This relatively common disorder can appear very unsightly but it is not contagious. It is caused when the body attacks its own skin cells, making too many new ones and causing a thick, red, scaly buildup. A recent study from Sweden found that severe psoriasis is actually more common in men than women. Interestingly, men often have worse prognosis and more severe autoimmune diseases than women. According to one study, about 30 percent of people with it will also develop psoriasis arthritis, a joint inflammation, although it is not exactly clear why. For psoriasis, treatments may include topical creams for mild cases, and a combination of creams and oral medications for more severe cases. Controlled exposure to sunlight may also help. Other skin-related autoimmune conditions include vitiligo in which the skin’s pigment is attacked, causing it to lose its colour; and scleroderma which causes an overgrowth of collagen.
Other autoimmune diseases
There are about eighty autoimmune diseases but some other common autoimmune diseases include:
• Multiple sclerosis (MS)
• Myasthenia gravis
• Vasculitis
• Alopecia or Alopecia Areata
• Sarcoidosis
• Temporal arteritis
Conclusion
There is no doubt that the incidence of autoimmune diseases is increasing in many countries including Anguilla. The symptoms are varied and many doctors find it challenging to confirm the diagnosis in a timely fashion. Once the diagnosis is made a variety of medication are used to control symptoms. If you have symptoms suggestive of an autoimmune disease contact your healthcare provider.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
