Autoimmune diseases, where the body’s immune system attacks healthy cells, affect at least 23.5 people million in the U.S., according to the National Institutes of Health. (Though the Autoimmune Related Diseases Association estimates that number is closer to 50 million.)
“It’s getting worse, it’s going up,” Harvard Medical School immunologist, pathologist and molecular microbiologist Dr. Noel Rose told TODAY.
Rose is known as the “father of immunology” in the medical community for his groundbreaking research in establishing the concept of autoimmune diseases.
“The problem is because the concept of an autoimmune disease is quite new; the autoimmune diseases are treated by different physicians and in different departments and they’re not thought of generally as a single entity the way cancer is thought of or infectious diseases are thought of,” said Rose.
Much research is needed, but advances are being made. Earlier this month, a donation of $125 million to fund immune research was made posthumously by Microsoft co-founder Paul Allen.
What are the symptoms?
An autoimmune (AI) disease can impact different parts of the body, which is one of the reasons why it can be difficult to diagnose.
“The classic teaching to medical students is that when a patient starts to have symptoms in more than one, and especially in three or more organ systems, you have to start thinking about autoimmune disease,” said NYU Langone rheumatologist and TODAY contributor Dr. Natalie Azar.
For example, a person who presents a rash (a skin issue), arthritis (a musculoskeletal issue) and a cough (a pulmonary issue), could have an autoimmune disease, Azar said. Though she added, they could also be truly unrelated or point to another disease, infection or cancer. That’s why if you’re not feeling well, it’s important to talk to a doctor and follow up if your symptoms persist.
Women are more likely than men to be diagnosed with one. A number of celebrities have been open about their struggle with AI diseases, including Zoe Saldana, Kelly Clarkson, Gigi Hadid, Selena Gomez and Hollywood icon Kathleen Turner.
What are common autoimmune diseases?
- Rheumatoid arthritis, a form of arthritis that attacks the joints
- Psoriasis, a condition marked by thick, scaly patches of skin
- Psoriatic arthritis, a type of arthritis affecting some people with psoriasis
- Lupus, a disease that damages areas of the body that include joints, skin and organs
- Thyroid diseases such as Graves’ disease and Hashimoto’s thyroiditis
Other common diseases are inflammatory bowel disease, where the immune system attacks the lining of the small or large intestine or colon. Multiple sclerosis (MS) where the immune system attacks the central nervous system. These are just a few, here is a more comprehensive list from the U.S. Department of Health & Human Services.
If you think you may have one of these diseases or were recently diagnosed, don’t jump to conclusions before consulting your primary care doctor, a specialist and perhaps another specialist for a second or third opinion.
“Some diseases can be life or organ threatening, to be sure ...” Azar said, “But many have very, very mild and manageable symptoms.”
“All require regular follow-up with a health care provider, to monitor for disease progression as well as potential side effects from medications and drug toxicities. A lot goes into the care of a patient with AI disease — family planning, fertility, vaccination schedules, drug monitoring and clinical follow-up, to name a few,” she added.
Ways to reduce your risk
Your genetics play a key role, but aren’t the direct cause.
“For most AI diseases, we say that to develop disease requires a genetic susceptibility, that with the right trigger, causes disease to develop. So genetics are necessary, but not sufficient,” said Azar.
As for what the exact trigger is, Azar explained: “That’s the holy grail of rheumatology and while we have a a lot of science telling us a lot of different things, not one unifying proven hypothesis exists for all disease.”
One of the biggest things you can do to reduce your risk is not smoke.
“One of the biggest modifiable risk factors is smoking, especially for rheumatoid arthritis and lupus. So the recommendation there is clear,” Azar said.
She also advised anti-inflammatory diets for people with a family history or those presenting early symptoms, but said it’s not a clear or one-stop solution.
“The immune response is a psychological response and it needs a good, healthy body,” said Rose.
Being overweight or obese could also raise your risk of certain autoimmune diseases, such as rheumatoid arthritis or psoriatic arthritis, according to Johns Hopkins rheumatologist Dr. Ana-Maria Orbai. Certain blood pressure medications could also trigger lupus in those predisposed to it, she noted, but added patients need to talk to their doctors before stopping any medication.
Rose underscored the need for more research: “It takes a lot of work and money to figure out the environmental causes of autoimmune disease are.”
What is common variable immunodeficiency?
A related issue involving the immune system is common variable immunodeficiency. It happens when a person has a low level of antibodies that help fight infections.
“The ‘variable’ in the name refers to the myriad clinical manifestations of this disorder, which could include recurrent infections, chronic lung disease, autoimmune disorders, gastrointestinal disease and even some cancers,” Azar said.
The diagnosis for it can be straightforward with a doctor looking at your family’s history, finding low levels of immunoglobulins that are tested in the blood, as well as demonstration of poor antibody responses to different vaccines, Azar adds.
If your primary care doctor is at a loss, a referral to an immunologist or other specialist is likely needed.