Autoimmune diseases – when the body fights itself. – Dzifa Dey
I struggled to explain to the gentleman who brought his wife to the clinic what an autoimmune disease is, as against his strong belief of a spiritual source to his wife’s illness. I could understand his skeptical look as he looked at me as if to say “ huh and you say it’s not spiritual!!! ”. As an African, with our natural belief in the spiritual and supernatural the thought of a disease that is caused by the body attacking itself understandably begins to sound supernatural.
So what are autoimmune diseases?
The word “auto” is a Greek word meaning self.
Your body’s immune system protects you from disease and infection .But if you have an autoimmune disease, your immune system cannot tell the difference between the healthy cells and the harmful cells in your body. The immune system becomes overactive and attacks and destroys the healthy cells by mistake. It does this by producing substances called antibodies that target the body’s tissue.
Autoimmune diseases together constitute the fourth largest cause of death among women. It affects more people than heart disease in the USA. It is poorly understood, poorly recognised and of apparent increasing incidence worldwide including Africa. There is therefore need to raise more awareness about such diseases as it can cause a lot of damage both physically and psychologically on both patients and their care givers.
What causes it?
Autoimmune disorders are still one of the big medical mysteries and though scientists still trying to decipher what causes it, they believe an interaction of genes and the environment is to be blamed. Some run in families, but most appear without warning and with no clear cause.
A few recent studies suggest that eating too much salt can predispose you to having autoimmune disease such as multiple sclerosis and smoking causes rheumatoid arthritis adding evidence to the belief that lifestyle choices and other environmental factors are behind the rise.
People with autoimmune diseases have an inherent predisposition to develop an over reactive immune response. Even with a genetic tendency, a person may not develop an autoimmune disease without an environmental influence or physical trauma to set it off.
Despite the genetic predisposition, most people would not develop the disease until there is an environmental trigger that sets the over active immune system off. These environmental influences include:
Infections: Bacterial or viral. Initial theories suggested parasitic infections may be protective, hence the low incidence in Africa where such infections abound in the past.
Drugs: certain drugs are known to trigger off some diseases e.g. drug induced lupus may be triggered by some antibiotics or antihypertensive drugs
Toxins including petroleum products and pesticides have been implicated as causing some diseases.
Sex: autoimmune conditions tend to have a female preponderance, about 75% of all cases may be women. These are usually pubertal or of childbearing age , so hormonal control is suggested.
Stressful life events can also trigger these conditions.
Some diseases and potential triggers are listed;
Lupus: hair dye and certain drugs, smoking
Scleroderma: silica exposure
Diabetes: gluten, coxsackie virus
Rheumatoid Arthritis: mycoplasmas, smoking
Multiple Sclerosis: hepatitis B infection
They can affect only one organ e.g. Diabetes mellitus type 1 where the pancreas is affected leading to reduced or absent insulin which is needed to process sugar, Graves disease where it affects the thyroid gland, or in multiple sclerosis, the covering of the nerves in the brain and spinal cord are affected leading to episodes of nerve dysfunction causing blindness, limb weakness etc.
It could also be systemic, that is more wide spread affecting a lot of organs at once or sequentially e.g. Lupus, Rheumatoid arthritis, polymyositis which can affect organs such as the joints, muscles , brain kidneys , lungs.
Other autoimmune diseases which can occur in different organ systems include:
- Gastrointestinal tract: Crohns disease ,Primary biliary cirrhosis, Autoimmune hepatitis
- Endocrine : Type 1 diabetes, Graves disease, Hashimotos thyroiditis
- Skin : pemphigus vulgaris
- Nervous system : multiple sclerosis, CIDP
- Haematologic : autoimmune hemolytic anaemia, pernicious anaemia
- Respiratory: sarcoidosis, interstitial lung disease
Symptoms and signs:
This would depend on the organ affected,but common symptoms include:
Malaise, fatigue, rashes, hair loss, febrile illness, recurrent miscarriages, visual impairment, joint swellings or pain, memory loss, limb weakness, strokes.
This depends on:
- Accurate history of the illness
- Physical examination by the doctor
- High index of suspicion
It is important to understand that there is no particular test (with a result that is either positive or negative) that can confirm or deny a diagnosis of an autoimmune disease. The doctor must take into account the patient’s entire medical history and all of the other signs and symptoms being experienced. This would be varied probable depending on the system involved.
Full blood counts, kidney function tests, thyroid function tests, blood sugar levels.
When you have an autoimmune disease, your body produces antibodies against some of your own tissues. Diagnosing an autoimmune disease involves identifying which antibodies your body is producing.
The following tests are used to diagnose an autoimmune disease:
Antinuclear antibody tests (ANA)—a type of autoantibody test that looks for antinuclear antibodies, which attack the nuclei of cells in your body
Autoantibody tests—other serological assays are antibody tests used for diagnosis and are unfortunately quite expensive locally in Ghana.
Imaging tests including x-rays, Ct scans and MRI scans.
Biopsies: that is taking of a piece of tissue for those with local or a particular organ involvement.
There is currently no cure for these chronic autoimmune conditions. Controlling the progression of the disease and decreasing the symptoms, especially during periods of increased activity are the main goals of treatment and disease management. If you have an autoimmune disease, you and your doctor will have to work together to create a plan to manage your symptoms.
Treatment methods depend on the disease, but in most cases one main goal that is common to most autoimmune diseases is the reduction of inflammation.
The treatment of autoimmune diseases is typically with immunosuppressive medications, which are used to reduce the hyperactive immune reaction.
These immune modulatory drugs include steroids, Cytotoxic drugs which include low doses of chemotherapeutic drugs like methotrexate and newer more targeted immune modulators called biologics e.g. Rituximab, TNF inhibitors etc.
Non immune therapy are used to replace for example certain hormones lost due loss of function of a gland for example thyroxine in thyroid disease, insulin in type 1 diabetes.
Anti inflammatory and analgesics e.g. NSAIDS for pain. These diseases are long term or chronic diseases and a multidisciplinary approach to treatment is crucial involving counselors, physiotherapists, Occupational therapists etc.
How do you prevent or control disease activity?
Drink water to stay hydrated
Eat a balanced and healthy diet
Get regular and gentle exercise
Make sure that you are well rested
Take vitamin supplements such as vitamin D (please consult your physician before taking any herbal supplements as they could interfere with the efficacy of any other prescribed medications)
Get physical therapy as needed to improve movement and reduce joint stiffness
Limit sun exposure for those with photosensitivity
Learn to understand and avoid any known triggers of flare-ups (increases in disease activity)
Now that you know, why don’t you save a life and spread the awareness.
Lets tRi together
The writer is a Physician Specialist & Rheumatologist
0244 672 343
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