Autoimmune diseases

Autoimmune diseases

Overview of Autoimmune Diseases

• The immune system is the network of cells and tissues throughout your body that work together to defend you from viruses, bacteria, and infection.
• It tries to identify, kill, and eliminate the invaders.

What happens in autoimmune diseases?

• Autoimmune diseases refer to problems with the acquired immune system’s reactions.
• Immune cells target the body’s own healthy tissues by mistake, signaling the body to attack them.

Proposed role of EBV infection in the development of chronic autoimmune diseases

Autoimmune diseases are a group of disorders in which the immune system mistakenly attacks the body's own healthy cells and tissues, causing inflammation and damage. In a properly functioning immune system, the body can distinguish between self and non-self, meaning it can recognize its own cells and foreign substances like pathogens. However, in autoimmune diseases, this ability is compromised, leading to the immune system targeting its own cells.

There are more than 80 known autoimmune diseases, and they can affect various parts of the body. Some of the most common autoimmune diseases include:

Rheumatoid arthritis: This disorder causes the immune system to attack the joints, leading to inflammation, pain, and eventual joint damage.

Systemic lupus erythematosis (SLE): SLE is a complex autoimmune disease that can affect multiple organs and systems in the body, causing inflammation and damage. Common symptoms include skin rashes, joint pain, fatigue, and kidney problems.

Type 1 diabetes: In this form of diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas, leading to a lack of insulin and high blood sugar levels.

Multiple sclerosis (MS): MS affects the central nervous system, causing the immune system to attack and damage the protective covering (myelin) around nerve fibers. This can lead to a wide range of symptoms, including muscle weakness, vision problems, and cognitive difficulties.

Common diseases

Inflammatory bowel diseases (IBD): Crohn's disease and ulcerative colitis are two types of IBD in which the immune system attacks the lining of the digestive tract, causing inflammation, pain, and digestive issues.

Psoriasis: This is a chronic skin condition characterized by the rapid buildup of skin cells, leading to the formation of red, scaly patches on the skin's surface. The immune system plays a key role in this abnormal skin cell growth.

The exact cause of autoimmune diseases is not well understood, but it is believed to involve a combination of genetic and environmental factors. Some factors that may increase the risk of developing an autoimmune disease include a family history of autoimmune disorders, exposure to certain environmental factors (such as infections or toxins), and being of a certain sex or ethnicity.

Diagnosis of autoimmune diseases can be challenging, as the symptoms can vary widely and often mimic those of other conditions. Blood tests to detect specific autoantibodies (proteins that attack the body's own cells) are commonly used to help diagnose these conditions, alongside other diagnostic tools such as imaging studies and biopsies.

Treatment for autoimmune diseases typically aims to manage symptoms and minimize damage to the affected organs and tissues. This often involves the use of medications to suppress the immune system's activity, such as corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and immunosuppressive medications. In some cases, more targeted therapies may be used to specifically address the underlying immune system dysfunction.

Types of Autoimmune Diseases

Some examples of autoimmune disease include:

Autoimmune Disorders Rheumatoid Arthritis and Lupus

• Alopecia areata.
• Autoimmune hemolytic anemia.
• Autoimmune hepatitis.
• Dermatomyositis.
• Diabetes (type 1).
• Glomerulonephritis.
• Granulomatosis with polyangiitis.
• Graves’ disease.
• Guillain-Barré syndrome.
• Idiopathic thrombocytopenic purpura.
• Some forms of juvenile idiopathic arthritis.
• Myasthenia gravis.
• Some forms of myocarditis.
• Multiple sclerosis.
• Pemphigus/pemphigoid.
• Pernicious anemia.
• Polyarteritis nodosa.
• Polymyositis.
• Primary biliary cirrhosis.
• Psoriasis.
• Rheumatoid arthritis.
• Scleroderma/systemic sclerosis.
• Sjögren’s syndrome.
• Systemic lupus erythematosus.
• Some forms of thyroiditis.
• Some forms of uveitis.
• Vitiligo.

How common are autoimmune diseases?

Overall, autoimmune diseases are common, affecting more than 23.5 million Americans. They are a leading cause of death and disability. Some autoimmune diseases are rare, while others, such as Hashimoto's disease, affect many people.

Hashimoto's thyroiditis

Who gets autoimmune diseases?

Autoimmune diseases can affect anyone. Yet certain people are at greater risk, including:

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Warm autoimmune hemolytic anemia

• Women of childbearing age — More women than men have autoimmune diseases, which often start during their childbearing years.
• People with a family history — Some autoimmune diseases run in families, such as lupus and multiple sclerosis. It is also common for different types of autoimmune diseases to affect different members of a single family. Inheriting certain genes can make it more likely to get an autoimmune disease. But a combination of genes and other factors may trigger the disease to start.
• People who are around certain things in the environment — Certain events or environmental exposures may cause some autoimmune diseases, or make them worse. Sunlight, chemicals called solvents, and viral and bacterial infections are linked to many autoimmune diseases.
• People of certain races or ethnic backgrounds — Some autoimmune diseases are more common or affect certain groups of people more severely. For instance, type 1 diabetes is more common in white people. Lupus is most severe for African-American and Hispanic people.

What autoimmune diseases affect women, and what are their symptoms?

The diseases listed here either are more common in women than men or affect many women and men. They are listed in alphabetical order.

Although each disease is unique, many share hallmark symptoms, such as fatigue, dizziness, and low-grade fever. For many autoimmune diseases, symptoms come and go, or can be mild sometimes and severe at others. When symptoms go away for a while, it's called remission. Flares are the sudden and severe onset of symptoms.

Types of autoimmune diseases and their symptoms

Disease	Symptoms
Alopecia areata (Al-uh-PEE-shuh AR-ee-AYT-uh) The immune system attacks hair follicles (the structures from which hair grows). It usually does not threaten health, but it can greatly affect the way a person looks.	Patchy hair loss on the scalp, face, or other areas of your body
Antiphospholipid (an-teye-FOSS-foh-lip-ihd) antibody syndrome (aPL) A disease that causes problems in the inner lining of blood vessels resulting in blood clots in arteries or veins.	Blood clots in veins or arteries Multiple miscarriages Lacy, net-like red rash on the wrists and knees
Autoimmune hepatitis The immune system attacks and destroys the liver cells. This can lead to scarring and hardening of the liver, and possibly liver failure.	Fatigue Enlarged liver Yellowing of the skin or whites of eyes Itchy skin Joint pain Stomach pain or upset
Celiac disease A disease in which people can't tolerate gluten, a substance found in wheat, rye, and barley, and also some medicines. When people with celiac disease eat foods or use products that have gluten, the immune system responds by damaging the lining of the small intestines.	Abdominal bloating and pain Diarrhea or constipation Weight loss or weight gain Fatigue Missed menstrual periods Itchy skin rash Infertility or miscarriages
Diabetes type 1 A disease in which your immune system attacks the cells that make insulin, a hormone needed to control blood sugar levels. As a result, your body cannot make insulin. Without insulin, too much sugar stays in your blood. High blood sugar can hurt the eyes, kidneys, nerves, and gums and teeth. But the most serious problem caused by diabetes is heart disease.	Being very thirsty Urinating often Feeling very hungry or tired Losing weight without trying Having sores that heal slowly Dry, itchy skin Losing the feeling in your feet or having tingling in your feet Having blurry eyesight
Graves' disease (overactive thyroid) A disease that causes the thyroid to make too much thyroid hormone.	Insomnia Irritability Weight loss Heat sensitivity Sweating Fine brittle hair Muscle weakness Light menstrual periods Bulging eyes Shaky hands Sometimes there are no symptoms
Guillain-Barre syndrome (GEE-yahn bah-RAY) The immune system attacks the nerves that connect your brain and spinal cord with the rest of your body. Damage to the nerves makes it hard for them to transmit signals. As a result, the muscles have trouble responding to the brain.	Weakness or tingling feeling in the legs that might spread to the upper body Paralysis in severe cases Symptoms often progress relatively quickly, over a period of days or weeks, and often occur on both sides of the body.
Hashimoto's disease (hah-shee-MOH-tohz) (underactive thyroid) A disease that causes the thyroid to not make enough thyroid hormone.	Fatigue Weakness Weight gain Sensitivity to cold Muscle aches and stiff joints Facial swelling Constipation
Hemolytic anemia (HEE-moh-lit-ihk uh-NEE-mee-uh) The immune system destroys the red blood cells. Yet the body can't make new red blood cells fast enough to meet the body's needs. As a result, your body does not get the oxygen it needs to function well, and your heart must work harder to move oxygen-rich blood throughout the body.	Fatigue Shortness of breath Dizziness Headache Cold hands or feet Paleness Yellowish skin or whites of eyes Heart problems, including heart failure
Idiopathic thrombocytopenic purpura (id-ee-oh-PATH-ihk throm-boh-seye-toh-PEE-nik PUR-pur-uh) (ITP) A disease in which the immune system destroys blood platelets, which are needed for blood to clot.	Very heavy menstrual period Tiny purple or red dots on the skin that might look like a rash. Easy bruising Nosebleed or bleeding in the mouth
Inflammatory bowel disease (IBD) A disease that causes chronic inflammation of the digestive tract. Crohn's (krohnz) disease and ulcerative colitis (UHL-sur-uh-tiv koh-LEYE-tuhss) are the most common forms of IBD.	Abdominal pain Diarrhea, which may be bloody Some people also have: Rectal bleeding Fever Weight loss Fatigue Mouth ulcers (in Crohn's disease) Painful or difficult bowel movements (in ulcerative colitis)
Inflammatory myopathies (meye-OP-uh-theez) A group of diseases that involve muscle inflammation and muscle weakness. Polymyositis (pol-ee-meye-uh-SYT-uhss) and dermatomyositis (dur-muh-toh-meye-uh-SYT-uhss) are 2 types more common in women than men.	Slow but progressive muscle weakness beginning in the muscles closest to the trunk of the body. Polymyositis affects muscles involved with making movement on both sides of the body. With dermatomyositis, a skin rash comes before or at the same time as muscle weakness. May also have: Fatigue after walking or standing Tripping or falling Difficulty swallowing or breathing
Multiple sclerosis (MUHL-tip-uhl sklur-OH-suhss) (MS) A disease in which the immune system attacks the protective coating around the nerves. The damage affects the brain and spinal cord.	Weakness and trouble with coordination, balance, speaking, and walking Paralysis Tremors Numbness and tingling feeling in arms, legs, hands, and feet Symptoms vary because the location and extent of each attack vary
Myasthenia gravis (meye-uhss-THEEN-ee-uh GRAV-uhss) (MG) A disease in which the immune system attacks the nerves and muscles throughout the body.	Double vision, trouble keeping a steady gaze, and drooping eyelids Trouble swallowing, with frequent gagging or choking Weakness or paralysis Muscles that work better after rest Drooping head Trouble climbing stairs or lifting things Trouble talking
Primary biliary cirrhosis (BIL-ee-air-ee sur-ROH-suhss) The immune system slowly destroys the liver's bile ducts. Bile is a substance made in the liver. It travels through the bile ducts to help with digestion. When the ducts are destroyed, the bile builds up in the liver and hurts it. The damage causes the liver to harden and scar, and eventually stop working.	Fatigue Itchy skin Dry eyes and mouth Yellowing of skin and whites of eyes
Psoriasis (suh-REYE-uh-suhss) A disease that causes new skin cells that grow deep in your skin to rise too fast and pile up on the skin surface.	Thick red patches, covered with scales, usually appearing on the head, elbows, and knees Itching and pain, which can make it hard to sleep, walk, and care for yourself May have: A form of arthritis that often affects the joints and the ends of the fingers and toes. Back pain can occur if the spine is involved.
Rheumatoid arthritis (ROO-muh-toid ar-THREYE-tuhss) A disease in which the immune system attacks the lining of the joints throughout the body.	Painful, stiff, swollen, and deformed joints Reduced movement and function May have: Fatigue Fever Weight loss Eye inflammation Lung disease Lumps of tissue under the skin, often the elbows Anemia
Scleroderma (sklair-oh-DUR-muh) A disease causing abnormal growth of connective tissue in the skin and blood vessels.	Fingers and toes that turn white, red, or blue in response to heat and cold Pain, stiffness, and swelling of fingers and joints Thickening of the skin Skin that looks shiny on the hands and forearm Tight and mask-like facial skin Sores on the fingers or toes Trouble swallowing Weight loss Diarrhea or constipation Shortness of breath
Sjögren's syndrome A disease in which the immune system targets the glands that make moisture, such as tears and saliva.	Dry eyes or eyes that itch Dryness of the mouth, which can cause sores Trouble swallowing Loss of sense of taste Severe dental cavities Hoarse voice Fatigue Joint swelling or pain Swollen glands Cloudy eyes
Systemic lupus erythematosus (LOO-puhss ur-ih-thee-muh-TOH-suhss) A disease that can damage the joints, skin, kidneys, heart, lungs, and other parts of the body. Also called SLE or lupus.	Fever Weight loss Hair loss Mouth sores Fatigue "Butterfly" rash across the nose and cheeks Rashes on other parts of the body Painful or swollen joints and muscle pain Sensitivity to the sun Chest pain Headache, dizziness, seizure, memory problems, or change in behavior
Vitiligo (vit-ihl-EYE-goh) The immune system destroys the cells that give your skin its color. It also can affect the tissue inside your mouth and nose.	White patches on areas exposed to the sun, or on armpits, genitals, and rectum Hair turns gray early Loss of color inside your mouth

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Insulitis

Are chronic fatigue syndrome and fibromyalgia autoimmune diseases?

Chronic fatigue syndrome, also known as myalgic encephalomyelitis, or ME/CFS, and fibromyalgia (feye-broh-meye-AL-juh) (FM) are not autoimmune diseases. But they often have symptoms of some autoimmune disease, like being tired all the time and pain.

• ME/CFS can cause you to be very tired, have trouble concentrating, feel weak, and have muscle pain. Symptoms of ME/CFS come and go. The cause of ME/CFS is not known.
• FM is a disorder in which pain or tenderness is felt in multiple places all over the body. These "tender points" are located on the neck, shoulders, back, hips, arms, and legs and are painful when pressure is applied to them. Other symptoms include fatigue, trouble sleeping, and morning stiffness. FM mainly occurs in women of childbearing age. But children, the elderly, and men are sometimes can also get it. The cause is not known.

How do I find out if I have an autoimmune disease?

Getting a diagnosis can be a long and stressful process. Although each autoimmune disease is unique, many share some of the same symptoms. And many symptoms of autoimmune diseases are the same for other types of health problems too. This makes it hard for doctors to find out if you really have an autoimmune disease, and which one it might be. But if you are having symptoms that bother you, it's important to find the cause. Don't give up if you're not getting any answers. You can take these steps to help find out the cause of your symptoms:

• Write down a complete family health history that includes extended family and share it with your doctor.
• Record any symptoms you have, even if they seem unrelated, and share it with your doctor.
• See a specialist who has experience dealing with your most major symptom. For instance, if you have symptoms of inflammatory bowel disease, start with a gastroenterologist. Ask your regular doctor, friends, and others for suggestions.
• Get a second, third, or fourth opinion if need be. If your doctor doesn't take your symptoms seriously or tells you they are stress-related or in your head, see another doctor.

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Butterfly rash of lupus erythematosus

What types of doctors treat autoimmune diseases?

Juggling your health care needs among many doctors and specialists can be hard. But specialists, along with your main doctor, may be helpful in managing some symptoms of your autoimmune disease. If you see a specialist, make sure you have a supportive main doctor to help you. Often, your family doctor may help you coordinate care if you need to see one or more specialists. Here are some specialists who treat autoimmune diseases:

Rheumatoid-Arthritis

• Nephrologist. A doctor who treats kidney problems, such as inflamed kidneys caused by lupus. Kidneys are organs that clean the blood and produce urine.
• Rheumatologist. A doctor who treats arthritis and other rheumatic diseases, such as scleroderma and lupus.
• Endocrinologist. A doctor who treats gland and hormone problems, such as diabetes and thyroid disease.
• Neurologist. A doctor who treats nerve problems, such as multiple sclerosis and myasthenia gravis.
• Hematologist. A doctor who treats diseases that affect blood, such as some forms of anemia.
• Gastroenterologist. A doctor who treats problems with the digestive system, such as inflammatory bowel disease.
• Dermatologist. A doctor who treats diseases that affect the skin, hair, and nails, such as psoriasis and lupus.
• Physical therapist. A health care worker who uses proper types of physical activity to help patients with stiffness, weakness, and restricted body movement.
• Occupational therapist. A health care worker who can find ways to make activities of daily living easier for you, despite your pain and other health problems. This could be teaching you new ways of doing things or how to use special devices. Or suggesting changes to make in your home or workplace.
• Speech therapist. A health care worker who can help people with speech problems from illness such as multiple sclerosis.
• Audiologist. A health care worker who can help people with hearing problems, including inner ear damage from autoimmune diseases.
• Vocational therapist. A health care worker who offers job training for people who cannot do their current jobs because of their illness or other health problems. You can find this type of person through both public and private agencies.
• Counselor for emotional support. A health care worker who is specially trained to help you to find ways to cope with your illness. You can work through your feelings of anger, fear, denial, and frustration.

Are there medicines to treat autoimmune diseases?

There are many types of medicines used to treat autoimmune diseases. The type of medicine you need depends on which disease you have, how severe it is, and your symptoms. Treatment can do the following:

• Relieve symptoms. Some people can use over-the-counter drugs for mild symptoms, like aspirin and ibuprofen for mild pain. Others with more severe symptoms may need prescription drugs to help relieve symptoms such as pain, swelling, depression, anxiety, sleep problems, fatigue, or rashes. For others, treatment may be as involved as having surgery.
• Replace vital substances the body can no longer make on its own. Some autoimmune diseases, like diabetes and thyroid disease, can affect the body's ability to make substances it needs to function. With diabetes, insulin injections are needed to regulate blood sugar. Thyroid hormone replacement restores thyroid hormone levels in people with underactive thyroid.
• Suppress the immune system. Some drugs can suppress immune system activity. These drugs can help control the disease process and preserve organ function. For instance, these drugs are used to control inflammation in affected kidneys in people with lupus to keep the kidneys working. Medicines used to suppress inflammation include chemotherapy given at lower doses than for cancer treatment and drugs used in patients who have had an organ transplant to protect against rejection. A class of drugs called anti-TNF medications blocks inflammation in some forms of autoimmune arthritis and psoriasis.

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