Exploring 7 Common Autoimmune Diseases, Management Tools
Despite no cures for autoimmune diseases, researchers are conducting studies to advance treatment and work toward a cure.
According to the Global Autoimmune Institute, autoimmune diseases are a category of illnesses that occur when the immune system attacks itself, mistaking a body’s own cells for foreign cells. There are roughly 80–100 known autoimmune disorders and many autoimmune-related conditions.
A comprehensive understanding of immune system function is vital to understand how autoimmune conditions impact the body. The immune system has two main components: the innate immune system and the adaptive system.
The innate immune system is the first defense against foreign materials such as bacteria, viruses, etc. When possible, pathogens are captured in mucosal membranes and released via coughing, sneezing, and other methods. The innate immune system also uses phagocytes to engulf and destroy pathogens.
These methods eliminate or delay pathogenic invasions until the adaptive immune system can kick in. The adaptive immune system uses B-cells to produce antibodies and T-cells to attack pathogens while indicating when to stop attacks.
Boston Children’s Hospital says, “In autoimmune disease, the immune system mistakenly begins attacking healthy cells and tissues — and fails to shut off the attack. This is different from other immune system malfunctions, such as acquired immunodeficiency disorders, like AIDS, in which the immune system is weakened or ineffective, and allergic disorders, in which the immune system overreacts to things like pollen or nuts.”
Although opinions on the most common autoimmune diseases can vary based on the source, the Global Autoimmune Institute lists the following as some of the most common autoimmune diseases:
- Alopecia areata
- Celiac disease
- Crohn’s disease (CD)
- Grave’s disease
- Hashimoto’s thyroiditis
- Multiple sclerosis (MS)
- Psoriasis
- Psoriatic arthritis (PA)
- Raynaud’s syndrome
- Rheumatoid arthritis (RA)
- Sjogren’s syndrome
- Systemic lupus erythematosus (SLE)
- Type 1 diabetes (T1D)
- Ulcerative colitis (UC)
- Vitiligo
This article provides an overview of some of the most frequently referred to, including the following: T1D, RA, psoriasis, SLE, inflammatory bowel disease (IBD), MS, and Sjogren’s syndrome.
Risk Factors
Multiple risk factors can increase the probability of developing an autoimmune disease. One of these factors is biological sex. Researchers postulate that hormonal changes and a second X chromosome make females 80% more likely to have an autoimmune disease.
In addition to biological sex, genetic factors such as variations in the HLA Q8 and HLA Q2 genes can alter a person’s immune response, leading to an autoimmune condition. Genetic conditions can be inherited or induced by environmental factors.
For example, smoking and exposure to toxic chemicals, such as air pollutants and organic solvents, can increase autoimmune disease risk.
Another risk factor is having an existing autoimmune disease. That typically indicates a genetic or environmental predisposition for autoimmune diseases. One-quarter of the people with an autoimmune condition are diagnosed with multiple autoimmune syndrome (MAS).
Obesity can also cause an increased risk of autoimmune diseases. Researchers postulate that increased adiposity can trigger a low-grade inflammatory response and alter immune system function.
Certain medications, such as immunotherapy for cancer, antibiotics, and blood pressure medications, can alter immune system responses, triggering autoimmune diseases.
A final common risk factor is an infectious disease that can alter genes and the immune system.
Diagnosis
Multiple diagnostic tests can be used to detect autoimmune conditions. The most common tests are the following:
- Antinuclear antibodies (ANA): These tests detect patterns or concentrations of autoantibodies.
- Autoantibodies: Much like ANA tests, autoantibody tests can also detect specific antibodies, such as rheumatoid factors, thyroid antibodies, and more, to detect specific conditions.
- Secretory IgA antibodies: Testing for secretory IgA antibodies can detect IgA deficiencies common in arthritis, lupus, celiac disease, ulcerative colitis, and Crohn’s disease.
- Thyroid function: A thyroid function panel can detect thyroid autoimmune diseases by measuring TSH levels, total T4, free T3 or T4, and reverse T3.
- Inflammation: Inflammatory biomarkers such as C-reactive protein (CRP) and erythrocyte sedimentation can be diagnostic tools for autoimmune diseases.
- Organ function: Tests that monitor organ function, such as endoscopies, colonoscopies, X-rays, and ultrasounds, can identify organ damage that may indicate an autoimmune disease.
Providers may also consider conducting a complete blood count (CBC), comprehensive metabolic panel (CMP), nutritional anemia profile, micronutrient deficiency tests, glucose regulation and metabolism test, organic acid tests (OAT), hormone level checks, genetic testing, and comprehensive stool analysis.
Type 1 Diabetes
Although diabetes is not generally considered an autoimmune disease due to the national understanding of type 2 diabetes, T1D is an autoimmune condition that targets beta cells in the pancreas, preventing them from producing insulin.
This condition is often diagnosed early in life — between 4 and 6 years old or during puberty. Unlike many other autoimmune diseases, T1D affects all patients relatively equally, with 1.24 million people in the United States having the condition.
Common symptoms include excessive thirst, frequent urination, unexplained weight loss, fatigue, blurred vision, and slow-healing cuts or sores.
Although the condition cannot be cured, managing T1D has been relatively well-established. Insulin, which can be delivered through multiple daily injections, insulin pens, a pump, or rapid-acting inhalation, is used to manage the condition.
Rheumatoid Arthritis
According to the American Academy of Rheumatology, RA is more likely to affect women, with 70% of patients being women.
RA causes stiff joints and swelling or pain in joints. RA is typically diagnosed with a physical exam, blood tests, and imaging, including X-rays, magnetic resonance imaging (MRI), or ultrasounds.
The standard treatment for RA is disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine. Biologics have also been used to manage RA.
Psoriasis
The National Psoriasis Foundation notes that psoriasis impacts over 7.5 million people in the US. Psoriasis is an autoimmune condition that presents as a skin disease. There are multiple types of psoriasis with varying symptoms; however, the most common symptoms include patchy rashes that vary in color, small scaling spots, dry, cracked skin, itching, burning, soreness, and cyclic rashes.
While the condition’s cause is not definitive, common triggers can include infections, weather changes, dermatologic injury, smoke exposure, heavy alcohol consumption, and more. However, the condition can be managed through topical therapies such as corticosteroids, vitamin D analogs, and retinoids.
Other treatments include light therapies and oral or injected medications.
Systemic Lupus Erythematosus
The CDC notes that lupus can affect all bodily organs. The most common symptoms include muscle and joint pain, fever, rashes, chest pain, hair loss, light sensitivity, kidney complications, mouth sores, fatigue, anemia, memory issues, blood clots, and ocular conditions.
A lupus diagnosis can be a complicated process, requiring providers to take an extensive medical history from patients to assess symptoms. Additionally, providers collect family history to determine whether lupus or other autoimmune diseases run in a patient’s family.
Other diagnostic tools may include a complete physical exam, blood or urine tests, and skin or kidney biopsies.
Like all autoimmune diseases, lupus has no known cure; however, providers have tools to manage symptoms or prevent flare-ups.
Healthcare providers typically prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to manage the condition.
Other drugs that may help manage the condition include antimalarial medications, BLyS-specific inhibitors, immunosuppressive agents, and other medicines to manage symptoms.
The most common form of lupus is systemic lupus erythematosus (SLE).
SLE is most common in women between 15 and 45; however, it can occur in anyone at any age. The NIH notes that the condition is more common in African American, American Indian, and Asian individuals.
Inflammatory Bowel Disease
The CDC notes that IBD can refer to Crohn’s disease or ulcerative colitis, which causes inflammation in the gastrointestinal tract. GI inflammation can cause persistent diarrhea, abdominal bleeding, weight loss, and fatigue.
IBD can be managed in multiple ways; most commonly, biologics are used to manage the condition. Other tools can include 5-aminosalicylic acids, immunomodulators, and corticosteroids. In severe cases, IBD requires surgical removal of damaged GI portions.
Multiple Sclerosis
Multiple sclerosis is a neurological autoimmune disease that impacts the central nervous system, including the brain, spinal cord, and optic nerves. In patients with MS, immune cells attack the myelin sheath that insulates nerve fibers.
This damage can lead to neurological symptoms such as numbness, tingling, cognitive impairment, mood and behavioral changes, and visual issues. Flare-ups of MS can be managed via corticosteroids and plasmapheresis.
Other tools include disease-modifying therapies (DMTs), such as interferon beta medications, glatiramer acetate, monoclonal antibodies, and more.
Sjogren’s Syndrome
Sjogren’s syndrome targets moisture-producing glands in the eyes, mouth, and other body parts.
The condition is most common in women in their 40s and 50s. There are two forms of Sjogren’s syndrome, primary and secondary. Primary Sjogren’s is diagnosed when a patient doesn’t have another rheumatic disease; secondary is when a patient has other comorbid autoimmune diseases.
Common symptoms of Sjogren’s include dry eyes, dry mouth, fatigue, joint pain, dry skin, skin rashes, muscle aches, vaginal dryness, trouble sleeping, and more.
Like other autoimmune diseases, Sjogren’s syndrome is diagnosed using an ANA. Clinicians may also use other diagnostic tools, including eye exams to evaluate dry eyes, RF tests, and salivary gland biopsies.
Once diagnosed, the condition can be managed through medications that relieve dryness symptoms, including eye drops for dry eyes and pilocarpine or cevimeline. Patients experiencing reflux may be prescribed proton-pump inhibitors or H2 blockers.
