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A healthy immune system protects the body from external threats such as viral and microbial infections, fights inflammation and cell transformation. It represents a strong line of defense against various external aggressors. However, when the immune system does not function properly, instead of the real aggressors attacking its host (the tissues and cells of the body), an autoimmune disease develops.
There are over 80 known autoimmune diseases. Currently, they affect more than 10 million people in the country. While many of these are fairly common, others are rare and difficult to diagnose. Scientists are still investigating what makes people vulnerable to autoimmune diseases and what exactly causes them. All autoimmune diseases have a so-called relapsing and relapsing course. That is, a person may have long periods when he feels relatively well, followed by exacerbations or outbreaks of severe illness.
In conditions such as rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease (IBD), and type 1 diabetes, the body mistakenly perceives cells from its own joints, skin, digestive tract, nerves, muscles, blood vessels, glands, or vital organs as foreign invaders. In response, the immune system forms so-called autoantibodies that target these normal cells as if they were harmful organisms that need to be destroyed.
Autoimmune disease is often misunderstood. The most common misconception is that autoimmunity is the cause of any condition in which inflammation is present. However, inflammation can be caused by many things, including warding off infection or healing from injuries and wounds, so in many cases inflammation is part of the healing process and is not a sign of abnormal immune function.
What are autoimmune diseases
Let’s discuss some of the most common autoimmune conditions:
Lupus (systemic lupus erythematosus). Lupus causes inflammation and cell damage that can affect several body systems, including the skin, joints, kidneys, brain, heart, lungs, and red blood cells (red blood cells). A “butterfly” rash that spreads down both cheeks and nose is a hallmark of lupus, although not everyone with this pathology necessarily develops it. Lupus flare-ups can be caused by sunlight, infections, or certain medications.
Women of childbearing age are the group most at risk for this chronic disease; however, lupus can also affect men, adolescents, and children.
Rheumatoid arthritis. Ревматоидный артрит поражает суставы и многие другие ткани. Воспаление повреждает слизистую оболочку суставов (или синовиальную оболочку), которая утолщается, что приводит к боли в суставах и отекам. По мере прогрессирования ревматоидного артрита может произойти необратимое повреждение суставов. Воспаление может повредить хрящи и кости, а суставы могут расшататься, стать болезненными, жесткими (тугоподвижными) и скованными, деформированными.Осложнения могут быть еще более серьезными. Ревматоидный артрит – это аутоиммунное заболевание, которое может быть связано с фиброзом легких. Легочный фиброз вызывает прогрессирующее рубцевание легких (замещение их ткани неактивными соединительно-тканными полосами). Поскольку объем легких постоянно уменьшается, у пациентов усиливается одышка. Ревматоидный артрит также может поражать пищевод и вызывать проблемы с глотанием. Около миллиона россиян страдают ревматоидным артритом, и женщины почти в три раза чаще болеют этим заболеванием.
Type 1 diabetes. Insulin is an important hormone that regulates blood glucose (or sugar) levels in the body. Left untreated, elevated blood sugar levels can lead to severe conditions (loss of consciousness, coma) and organ damage over time. In type 1 diabetes, the immune system targets insulin-producing cells in the pancreas called beta cells. As beta cells are destroyed, the body cannot produce enough insulin, causing blood sugar to rise to dangerously high levels.
Type 1 diabetes, if not properly controlled, can cause serious complications affecting the heart, blood vessels, nerves, kidneys, eyes, feet, and skin of the body. Diabetic ketoacidosis is a life-threatening emergency that occurs when the body burns fat instead of glucose and the blood becomes acidic (too many ketone bodies). This complication of uncontrolled type 1 diabetes can lead to coma if left untreated.
Type 1 diabetes, which is usually diagnosed during childhood, adolescence, or early adulthood.
Diseases of the thyroid gland. Thyroid hormones regulate how the body uses energy or regulates metabolism. These hormones affect various organs and functions, including heart rate, weight loss and gain, cold tolerance, muscle control, and mood. An autoimmune disease can affect the thyroid gland, causing it to produce too much thyroid hormone (Graves’ disease) or too little (Hashimoto’s thyroiditis).
Graves’ disease affects less than 1% of people and is eight times more common in women than men. Hashimoto’s thyroiditis affects up to 5% of people, and is also more common in women.
Psoriasis and psoriatic arthritis. In psoriasis, the immune system attacks healthy skin cells, causing red, itchy, scaly, and uncomfortable skin plaques. It also causes systemic inflammation that can affect the heart and other organs. Psoriatic arthritis and the associated inflammatory lesion causes joint pain, swelling, and damage. Up to 30% of people with psoriasis develop psoriatic arthritis. Skin damage often appears between the ages of 15 and 25, and arthritis usually develops between ages 30 and 50.
Myasthenia gravis. The term myasthenia gravis means severe muscle weakness. In this condition, immune system proteins block the chemical communication between nerves and muscles. This disrupts proper muscle contraction and leads to muscle weakness.
The muscles involved in breathing, moving the arms and legs, moving the eyes and eyelids, chewing, and talking suffer. Myasthenia gravis can affect swallowing and facial expressions. Muscle weakness tends to worsen after physical activity and improves after rest.
Vasculitis. Vasculitis is swelling and inflammation of the blood vessels. ANCA vasculitis is a type of autoimmune vasculitis. Auto-antibodies called ANCA (anti-neutrophil cytoplasmic antibodies) target white blood cells called neutrophils, which then attack the small blood vessels in the body. Polyarteritis nodosa, another type of vasculitis that affects the arteries.
Common symptoms of ANCA vasculitis include joint and muscle pain, fever, and night sweats. When the kidneys are affected, high blood pressure, decreased kidney function, and kidney failure can occur. Lung involvement can lead to chest pain and hemoptysis. In polyarteritis nodosa, damage to the arteries can lead to high blood pressure, aneurysms, blood clots, and damage to organs, especially the kidneys. Various organs are affected, depending on where the vasculitis is most pronounced. For example, ANCA vasculitis can cause problems ranging from skin rashes to severe kidney damage.
Inflammatory bowel disease. Ulcerative colitis and Crohn’s disease are chronic inflammatory conditions of the digestive tract. They can lead to severe and distressing symptoms such as severe diarrhea and abdominal pain. Both fall under the umbrella term inflammatory bowel disease (IBD).
Although the exact cause is not clear, IBD is believed to have autoimmune and genetic components. People aged 45 and older are more likely to report IBD.
Multiple sclerosis. Myelin is a protective sheath or layer of insulation that covers the nerves. In multiple sclerosis (MS), the immune system attacks the myelin around the spinal cord, brain, and optic nerve fibers. This disrupts the flow of information from the brain to the rest of the body. MS can be relatively mild or cause movement problems, numbness and weakness, unilateral vision loss, fatigue, dizziness, slurred speech, and other symptoms. Women are more likely to get MS, and it can run in families.
Scleroderma. Склеродермия – это заболевание, поражающее кожу и соединительные ткани по всему телу. При склеродермии, что дословно означает «твердая кожа», организм вырабатывает слишком много дефектного белка коллагена. Коллаген обеспечивает структуру мышц, соединительной ткани и кожи, а также повышает эластичность кожи. У некоторых пациентов склеродермия поражает только кожу, в то время как другие пациенты страдают от системных эффектов, которые могут воздействовать на несколько областей тела. Избыток коллагена может накапливаться в различных органах, нарушая их функцию. Например, склеродермия может повлиять на легкие двумя способами: она может вызвать фиброз или привести к легочной гипертензии, то есть высокому кровяному давлению в легких.
Skin diseases. Некоторые аутоиммунные заболевания в основном связаны с кожей. К ним относятся болезни с образованием пузырей, такие как пузырчатка, буллезный пемфигоид и герпетиформный дерматит, который связан с чувствительностью к глютену из-за целиакии.
Other types. Other autoimmune conditions include Sjögren’s syndrome, juvenile arthritis, sarcoidosis, and eosinophilic esophagitis, a digestive disorder involving multiple food allergies.
How are autoimmune diseases treated?
The treatment of autoimmune diseases includes a number of major categories. This is only a partial list – additional options are available for certain conditions. The treating physician should explain the benefits, side effects, and risks of any treatment being considered.
Medicines
Steroids. Glucocorticoid drugs are commonly used as the initial treatment for autoimmune conditions. These drugs fight inflammation and reduce the activity of the immune system.
Non-steroidal anti-inflammatory drugs or NSAIDs. These are familiar medicines that can reduce inflammation and relieve symptoms.
local medicines. Ointments and creams containing corticosteroids, vitamin D, or other ingredients may help treat psoriasis.
Immunosuppressants. Such drugs suppress the immune system globally, but at the level of the whole organism.
Biopreparation. These targeted immunosuppressants block precise immune pathways in cells. TNF inhibitors, a category of biologics that act on a substance called tumor necrosis factor in the blood. They help reduce symptoms.
interferon beta preparations. These injectables are used to reduce the recurrence of multiple sclerosis.
Hormone replacement. Conditions that prevent the body from producing a particular hormone require constant replacement with medications such as insulin (type I diabetes) or thyroid pills (hypothyroidism).
Внутривенный иммуноглобулин. This treatment, sometimes referred to as IVIG, involves a blood product containing antibodies.
Therapy and procedures
Light therapy. Phototherapy with natural sunlight or artificial ultraviolet light can relieve the symptoms of psoriasis. Laser therapy is also sometimes used for more advanced forms of psoriasis.
Physical and occupational therapy. Специалисты по физиотерапии работают с пациентами, которым могут быть полезны физические упражнения, ходунки, трости или другие средства передвижения, а также устройства и методы, помогающие им выполнять повседневные функции.
Plasmapheresis This is also called plasma exchange and involves the removal, processing and replacement of plasma (the liquid part of the blood). Purified plasma does not contain antibodies that attack tissues in the body.
Kidney dialysis. Dialysis is used to remove excess fluid and metabolic waste products, replacing functions that diseased kidneys can no longer perform.
operations
Operations on the joints. Процедуры, включая синовэктомию (удаление слизистой оболочки сустава), сращение суставов и полная замена сустава могут быть вариантами для пациентов с запущенным ревматоидным артритом.
Thymectomy. Surgical removal of the thymus gland, a small gland associated with the immune system, can sometimes improve myasthenia gravis.
Thyroidectomy. This operation involves the complete or partial removal of the thyroid gland, for example, to treat goiter or hyperthyroidism.
Vascular shunting. This surgery is sometimes used to redirect blood flow around blocked blood vessels in patients with vasculitis.
Gastrointestinal surgery. Small bowel resection, which removes all or part of the small intestine, and colectomy, which removes all or part of the colon or large intestine, are sometimes used to treat inflammatory bowel disease.
Kidney transplant. Patients with severe kidney disease due to an autoimmune disease such as lupus may benefit from a kidney transplant.
Home treatment and disease control
Self-management and lifestyle interventions can help control autoimmune conditions and improve quality of life. This direction may include the following:
- physical activity can relieve symptoms and help control rheumatoid arthritis, type 1 diabetes and other autoimmune diseases, exercise can also improve mood;
- людям с диабетом 1 типа необходим частый мониторинг уровня глюкозы в крови, чтобы контролировать дозирование инсулина и поддерживать стабильный уровень глюкозы в крови;
- Sun protection is critical for people with lupus—hats, long shirts, umbrellas, and sunscreen are essential for protection—controlled exposure to sunlight can improve skin symptoms of psoriasis.
Prevention of autoimmune diseases
Unfortunately, there are no real ways to prevent these diseases. Their cause is unknown, therefore, prevention consists only in maintaining a healthy lifestyle.
Popular questions and answers
We asked questions about autoimmune diseases and their causes, symptoms therapist, gastroenterologist Vera Samsonova.
The role of stress in autoimmune disease is unclear. Scientists have found a higher incidence of autoimmune diseases among people who have previously been diagnosed with stress-related conditions. Although this is an interesting observation, it cannot be argued that stress causes immune diseases, especially since the concept of “stress” is not just one thing, it has many definitions. So far, research has not shed light on why and how stress can lead to autoimmune diseases.
Almost all of us have stress, but most people with stress do not suffer from autoimmune diseases. If there is any link, it is probably one of the many factors that increase the risk of such diseases.
Common autoimmune symptoms:
● fatigue;
● общее недомогание.
Rheumatoid arthritis:
● warm, swollen, swollen joints;
● stiffness of the joints, especially on awakening and after inactivity;
● deformation of the joints.
Type 1 diabetes mellitus:
● frequent urination;
● increased thirst;
● dry mouth;
● increased appetite;
● unexplained weight loss.
Volcanka:
● fever;
● pain in muscles and joints;
● rash, including redness on the face like “butterfly”;
● sensitivity to the sun and light;
● выпадение волос;
● mouth ulcers and kidney problems;
● concomitant symptoms such as swollen ankles and high blood pressure.
Graves’ disease causing hyperthyroidism:
● enlargement of the thyroid gland (goiter);
● anxiety and irritability;
● sensitivity to heat;
● повышенное потоотделение;
● changes in the menstrual cycle;
● unexplained weight loss.
Hashimoto’s thyroiditis causing hypothyroidism:
● enlarged thyroid gland;
● cold intolerance;
● unexplained weight gain;
● constipation;
● dryness and thinning of hair;
● increased heart rate.
Psoriasis:
● red, raised, inflamed areas of the skin;
● серебристые чешуйки или бляшки на коже;
● утолщенные ногти без ямок;
● сухая, потрескавшаяся кровоточащая кожа;
● swollen, painful joints.
Myasthenia gravis:
● слабость в руках, кистях, пальцах, шее или ногах;
● опущение век (птоз);
● change in facial expressions;
● clouding or double vision;
● difficulty swallowing.
Vasculitis:
● rash;
● blood or protein in the urine;
● body aches, fever, night sweats;
● joint and muscle pain.
Inflammatory bowel disease:
● abdominal pain;
● persistent diarrhea;
● bloody stools;
● rectal bleeding;
● weight loss.
Рассеянный склероз:
● numbness or tingling of the face, body or limbs;
● weakness;
● dizziness or balance problems;
● problems with walking or gait;
● непроизвольные мышечные спазмы;
● нечеткое зрение, плохое цветовое зрение;
● pain when moving the eyes;
● bladder and bowel problems.
Autoimmune skin diseases:
● волдыри на поверхности кожи или во рту, наполненные жидкостью;
● покраснение или раздражение кожи;
● rashes.
Scleroderma:
● skin is thickened, coarsened, shiny;
● swollen, thick fingers;
● pale fingers with sensitivity to cold, ulcers on fingertips and joints;
● complications such as scarring of the lungs, shortness of breath and heart problems, arrhythmia.
If you are concerned that you may have an autoimmune disease such as lupus, rheumatoid arthritis, thyroid disease, or type 1 diabetes, avoid the temptation to take supplements or go on a diet. Instead, see a doctor. A specific diagnosis and appropriate treatment can make a big difference—it can even save a life.