Autoimmune Disorders: When the Immune System Attacks

Autoimmune disorders are both quite common in the United States – affecting between 14 and 23 million people – as well as being varied in presentation and treatment. The first question we have to answer is “What is an autoimmune disorder?” The term autoimmune disorder actually encompasses a wide variety of diseases that are unified by one cause, which is that the patient’s own immune system is attacking their own tissues. Normally, the immune system attacks foreign invaders, keeping us safe from viruses and bacteria and helping the body keep cancer cells from taking hold and multiplying.

Some examples of autoimmune disease are Type I Diabetes, Rheumatoid Arthritis, Systemic Lupus Erythematosus (SLE), Hashimoto’s Thyroiditis, Crohn’s disease, and Psoriasis. Currently there are over 80 identified autoimmune diseases and suspected autoimmune diseases. Autoimmune diseases are becoming more commonly diagnosed, although it is not truly known whether or not they actually are increasing or it is only the diagnosis of autoimmune disorders that is increasing.

The immune system can go wrong in a multitude of ways. For instance, those seasonal allergies that plague you during spring and fall are a type of immune response to pollens in the air. A life-threatening allergic response, called anaphylaxis, is an extreme over response of the immune system to a trigger, most often something like peanuts, shellfish, or antibiotics. These are all mediated by something called the immuno globulin E antibodies (IgE), which trigger mast cells to release inflammatory chemicals called histamines. That is why antihistamines can work to control seasonal allergy symptoms as well as help treat anaphylaxis.

However, autoimmune disorders operate through other pathways. Autoimmune disorders can be mediated by T cells – the same cells involved in HIV – as well as B cells and other parts of the immune system. Essentially, what happens is that some part of the immune system comes to recognize something on your own cells as foreign that must be attacked. This is why certain autoimmune diseases seem to attack particular types of tissues. SLE is known to involve the basement membrane in the kidneys, Sjogren’s Syndrome involves connective tissue, and psoriasis involves the skin.

The most commonly implicated causes of autoimmune disorders are viruses. Some of the identified viruses involved in autoimmune disorder triggering are Coxsackie virus, rotavirus, as well as influenza A and herpesviruses. All are very common in both the adult and child population, and certainly having one of these viruses is not a guarantee that someone will experience an autoimmune disorder. There is a genetic component to autoimmune disorders, which can vary based on the instigating factor as well as the ultimate disease. The instigating mechanism of a virus causing an autoimmune disease is thought to be viral surface proteins which strongly resemble proteins found on specific human cells. This is probably why many types of autoimmune disorders are fairly specific in the type of tissues that they affect.

Essentially, you can think of it in this way: your immune system detects the virus, identifies it as foreign and attacks it. Once it is finished attacking and disposing of the virus, the cells responsible for that defense form a “memory” of the attacking virus. Once those dormant virus-attacking cells are in storage, they can respond much more quickly to the next time that virus attacks. This is what grants you immunity, for some period, from that virus. In an autoimmune disease, however, that memory cell mistakes your own tissue for the virus. It then sets out to attack the tissue–thinking that it is a foreign invader– which then causes the signs and symptoms of disease. That is the essence of an autoimmune disease.

Autoimmune diseases can involve any, and even a multitude of, organ systems. This is what makes them so maddeningly difficult to diagnose. The average time of diagnosis for most autoimmune disorders is between 2 and 4.5 years from the time the patient first presents to their first physician. Almost universally, the initial complaints that a patient will have are vague, such as fatigue, muscle or joint aches, rash, and shortness of breath. Any of these symptoms either separately or together could be indicative of a number of different causes.

One of the things that can make an autoimmune disease stand out for both the patient and physician is if a patient complains of having a problem that goes on for a few weeks or months; which then goes away for a while and then returns. There is a good chance that anything with a cyclic presentation is an autoimmune disorder. However, even our best tests are fairly insensitive (not very good at detecting) for autoimmune disorders. Often, a patient will be tested at one point in time for some of the common markers of autoimmune disorders only to return negative. A year later we can do the same test for the same symptoms and have them come up positive.

For most autoimmune disorders, the sooner they are diagnosed, the better the long-term prognosis for the patient. This is especially true in multiple sclerosis, Graves’ disease and Hashimoto Thyroiditis – among others. For multiple sclerosis which has a fairly distinct cyclic pattern as well as neurological symptoms – although some patients do present with ongoing symptoms – the sooner the disease is recognized and treatment started the better they long-term prognosis for the patient. This is incredibly important because multiple sclerosis can prove to be extremely debilitating and life-threatening in its later stages.

Perhaps you are having an ongoing problem with fatigue, rashes, joint aches or cyclical weakness in your extremities, and you suspect you have an autoimmune disorder, what can you do? Well first, you need to be your own strongest advocate. Because of the extremely limited nature of insurance-based healthcare, it is very difficult to get a physician’s attention for long enough to get them to understand the complexity of an autoimmune disorder’s presentation. Meanwhile make sure that you are getting good nutrition, taking a daily multi-vitamin supplement, and pay particular attention to your vitamin D levels, as it has been implicated in Autoimmune Disease—although it may be the result of the disease and not a cause. Every year you should have your vitamin D levels tested and your vitamin D supplementation adjusted to make sure you are within a normal range. However, be sure you don’t megadose vitamin D as there are risks to excessive vitamin D usage.

Given the length-of-time to diagnosis, it is essentially the standard-of-care for autoimmune disorders to be missed for the first couple of years. And, even if you are lucky enough to be sent to a rheumatologist for further workup, you are more likely to get a nonspecific “trashcan” diagnosis than a specific autoimmune disorder diagnosis at first. Most autoimmune disorder patients receive some other diagnosis, often one involving an emotional state such as depression, anxiety, hypochondriosis, or malingering.  While many autoimmune disorder patients undoubtedly do experience depression and anxiety because of their inability to get a diagnosis, these are not the causes of their symptoms, and they can quite reasonably feel like they are just being “put-off” by their doctors.

Autoimmune diseases are treatable. Treatment ranges from nonsteroidal anti-inflammatory drugs (NSAIDS)—such as Ibuprofen and Naprosyn—to nonspecific immune system suppressants like steroids to tailored medications that can block the inflammatory pathway that causes a patient’s specific autoimmune disease. The benefit of these more targeted treatments are that they have a much less significant impact on the patient’s ability to defend against infectious diseases, and do not inadvertently affect other systems in the body.

One of the great benefits to Direct Primary Care (DPC) is that we are able to spend enough time with patients, and have close and frequent enough follow-up, that we are able to both listen to our patients as well is entertain a wide range of diagnostic possibilities. I have had several patients that I suspected of autoimmune disease, and one in particular who had been suffering from multiple sclerosis for years, who I was able to diagnose by virtue of a simple thorough history and complete neurological examination—which she had been unable to obtain for several years prior to becoming my patient. This allowed her to start getting treatment and improved her life significantly.

If you have any questions about autoimmune disorders, or you would like a referral to a caring Direct Primary Care physician in your area, please email me at DrEdwards@wowhealingcare.com or call me at 760 – 425 – 4466. You can also check out the DPC mapper at DPCfrontier.com.