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What Are
Autoimmune Diseases?
The word "auto" is the Greek word for
self. The immune system is a complicated network of cells and cell
components (called molecules) that normally work to
defend the body and eliminate infections caused by bacteria,
viruses, and other invading microbes. If a person has an
autoimmune disease, the immune system mistakenly attacks self,
targeting the cells, tissues, and organs of a person's own body. A
collection of immune system cells and molecules at a target site
is broadly referred to as inflammation.
There are many different autoimmune diseases, and they can each
affect the body in different ways. For example, the autoimmune
reaction is directed against the brain in multiple sclerosis and
the gut in Crohn's disease. In other autoimmune diseases such as
systemic lupus erythematosus (lupus), affected tissues and organs
may vary among individuals with the same disease. One person with
lupus may have affected skin and joints whereas another may have
affected skin, kidney, and lungs. Ultimately, damage to certain
tissues by the immune system may be permanent, as with destruction
of insulin-producing cells of the pancreas in Type 1 diabetes
mellitus.
Who Is Affected
by Autoimmune Diseases?
Many of the autoimmune diseases are rare. As a
group, however, autoimmune diseases afflict millions of Americans.
Most autoimmune diseases strike women more often than men; in
particular, they affect women of working age and during their
childbearing years.
Some autoimmune diseases occur more frequently in certain minority
populations. For example, lupus is more common in African-American
and Hispanic women than in Caucasian women of European ancestry.
Rheumatoid arthritis and scleroderma affect a higher percentage of
residents in some Native American communities than in the general
U.S. population. Thus, the social, economic, and health impact
from autoimmune diseases is far-reaching and extends not only to
family but also to employers, co-workers, and friends.
How Are
Autoimmune Diseases Treated?
Autoimmune diseases are often chronic, requiring
lifelong care and monitoring, even when the person may look or
feel well. Currently, few autoimmune diseases can be cured or made
to "disappear" with treatment. However, many people with
these diseases can live normal lives when they receive appropriate
medical care.
Physicians most often help patients manage the consequences of
inflammation caused by the autoimmune disease. For example, in
people with Type 1 diabetes, physicians prescribe insulin to
control blood sugar levels so that elevated blood sugar will not
damage the kidneys, eyes, blood vessels, and nerves. However, the
goal of scientific research is to prevent inflammation from
causing destruction of the insulin-producing cells of the
pancreas, which are necessary to control blood sugars.
On the other hand, in some diseases such as lupus or rheumatoid
arthritis, medication can occasionally slow or stop the immune
system's destruction of the kidneys or joints. Medications or
therapies that slow or suppress the immune system response in an
attempt to stop the inflammation involved in the autoimmune attack
are called immunosuppressive medications. These drugs include
corticosteroids (prednisone), methotrexate, cyclophosphamide,
azathioprine, and cyclosporin. Unfortunately, these medications
also suppress the ability of the immune system to fight infection
and have other potentially serious side effects.
In some people, a limited number of immuno-suppressive medications
may result in disease remission. Remission is the medical term
used for "disappearance" of a disease for a significant
amount of time. Even if their disease goes into remission,
patients are rarely able to discontinue medications. The
possibility that the disease may restart when medication is
discontinued must be balanced with the long-term side effects from
the immunosuppressive medication.
A current goal in caring for patients with autoimmune diseases is
to find treatments that produce remissions with fewer side
effects. Much research is focused on developing therapies that
target various steps in the immune response. New approaches such
as therapeutic antibodies against specific T cell molecules may
produce fewer long-term side effects than the chemotherapies that
now are routinely used.
Ultimately, medical science is striving to design therapies that
prevent autoimmune diseases. To this end, a significant amount of
time and resources are spent studying the immune system and
pathways of inflammation.
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The
Whole Story