Autoimmune disorders are conditions in which a person's immune system attacks the body's own cells, causing tissue destruction.
Description
Autoimmunity is accepted as the cause of a wide range of disorders and suspected to be responsible for many more. Autoimmune diseases are classified as either general (the autoimmune reaction takes place simultaneously in a number of tissues) or organ specific (the autoimmune reaction targets a single organ).
Autoimmune disorders include the following:
Systemic lupus erythematosus. A general autoimmune disease in which antibodies attack a number of different tissues. The disease recurs periodically and is seen mainly in young and middle-aged women.
Rheumatoid arthritis. Occurs when the immune system attacks and destroys the tissues that line bone joints and cartilage. The disease occurs throughout the body, although some joints may be more affected than others.
Goodpasture's syndrome. Occurs when antibodies are deposited in the membranes of both the lung and kidneys, causing both inflammation of kidney glomerulus (glomerulonephritis) and lung bleeding. It is typically a disease of young males.
Grave's disease. Triggered by an antibody that binds to specific cells in the thyroid gland, causing them to make excessive amounts of thyroid hormone.
Pemphigus vulgaris. A group of autoimmune disorders that affect the skin.
Myasthenia gravis. A condition in which the immune system attacks a receptor on the surface of muscle cells, preventing the muscle from receiving nerve impulses and resulting in severe muscle weakness.
Pernicious anemia. Disorder in which the immune system attacks the lining of the stomach in such a way that the body cannot metabolize vitamin B12.
Sjögren's syndrome. Occurs when the exocrine glands are attacked by the immune system, resulting in excessive dryness.
Ankylosing spondylitis. Immune-system induced degeneration of the joints and soft tissue of the spine.
Vasculitis. A group of autoimmune disorders in which the immune system attacks and destroys blood vessels.
Type I diabetes mellitus. May be caused by an anti-body that attacks and destroys the islet cells of the pancreas that produce insulin.
Causes and symptoms
The symptoms of the above disorders include:
Systemic lupus erythematosus. Symptoms include fever, chills, fatigue, weight loss, skin rashes (particularly the classic "butterfly" rash on the face), vasculitis, polyarthralgia, patchy hair loss, sores in the mouth or nose, lymph-node enlargement, gastric problems, and, in women, irregular periods. About half of those who suffer from lupus develop cardiopulmonary problems, and some may also develop urinary problems. Lupus can also effect the central nervous system, causing seizures, depression, and psychosis.
Rheumatoid arthritis. Initially may be characterized by a low-grade fever, loss of appetite, weight loss, and a generalized pain in the joints. The joint pain then becomes more specific, usually beginning in the fingers, then spreading to other areas, such as the wrists, elbows, knees, and ankles. As the disease progresses, joint function diminishes sharply and deformities occur, particularly the characteristic "swan's neck" curling of the fingers.
Goodpasture's syndrome. Symptoms are similar to that of iron deficiency anemia, including fatigue and pallor. Symptoms involving the lungs may range from a cough that produces bloody sputum to outright hemorrhaging. Symptoms involving the urinary system include blood in the urine and/or swelling.
Grave's disease. This disease is characterized by an enlarged thyroid gland, weight loss without loss of appetite, sweating, heart palpitations, nervousness, and an inability to tolerate heat.
Hashimoto's thyroiditis. This disorder generally displays no symptoms. If symptoms do occur, it is most often weight gain, intolerance to cold, fatigue, enlarged neck or goiter, and constipation. About 25% of patients may be subject for developing pernicious anemia, diabetes, adrenal insufficiency, or other autoimmune diseases.
Pemphigus vulgaris. This disease is characterized by blisters and deep lesions on the skin. It is associated with other autoimmune diseases, such as systemic lupus and myasthenia gravis.
Myasthenia gravis. Characterized by fatigue and muscle weakness that at first may be confined to certain muscle groups, but then may progress to the point of paralysis. Myasthenia gravis patients often have expressionless faces as well as difficulty chewing and swallowing. If the disease progresses to the respiratory system, artificial respiration may be required.
Scleroderma. Disorder is usually preceded by Raynaud's phenomenon. Symptoms that follow include pain, swelling, and stiffness of the joints, and the skin takes on a tight, shiny appearance. The digestive system also becomes involved, resulting in weight loss, appetite loss, diarrhea, constipation, and distention of the abdomen. As the disease progresses the heart, lungs, and kidneys become involved, and malignant hypertension causes death in approximately 30% of cases.
Autoimmune hemolytic anemia. May be acute or chronic. Symptoms include fatigue and abdominal tenderness due to an enlarged spleen.
Polymyositis and dermatomyositis. In polymyositis, symptoms include muscle weakness, particularly in the shoulders or pelvis, that prevents the patient from performing everyday activities. In dermatomyositis, the same muscle weakness is accompanied by a rash that appears on the upper body, arms, and fingertips. A rash may also appear on the eyelids, and the area around the eyes may become swollen.
Pernicious anemia. Signs of pernicious anemia include weakness, sore tongue, bleeding gums, and tingling in the extremities. Because the disease causes a decrease in stomach acid, nausea, vomiting, loss of appetite, weight loss, diarrhea, and constipation are possible. Also, because vitamin B12 is essential for the nervous system function, the deficiency of it brought on by the disease can result in a host of neurological problems, including weakness, lack of coordination, blurred vision, loss of fine motor skills, loss of the sense of taste, ringing in the ears, and loss of bladder control.
Sjögren's syndrome. Characterized by excessive dryness and itching of the eyes and dry mouth. Difficulty swallowing, hoarseness, loss of taste, and severe dental caries may also occur. Other symptoms are fatigue, joint pain, and swelling of the glands.
Ankylosing spondylitis. Generally begins with lower back pain that progresses up the spine. The pain may eventually become crippling.
Vasculitis. Symptoms depend upon the group of veins affected and can range greatly. Some forms of vasculitis may be caused by allergy or hypersensitivity to medications such as sulfa or penicillin, other drugs, toxins, and other inhaled environmental irritants. Other forms may be due to infection, parasites, or viral infections. These causes need to be ruled out before considering an underlying autoimmune disorder.
To further understand autoimmune disorders, it is helpful to understand the workings of the immune system. The purpose of the immune system is to defend the body against attack by infectious microbes (germs) and foreign objects. When the immune system attacks an invader, it is very specific—a particular immune system cell will only recognize and target one type of invader. To function properly, the immune system must not only develop this specialized knowledge of individual invaders, but it must also learn how to recognize and not destroy cells that belong to the body itself. Every cell carries protein markers on its surface that identifies it in one of two ways: what kind of cell it is (i.e., nerve cell, muscle cell, blood cell, etc.) and to whom that cell belongs. These markers are called major histocompatability complexes (MHCs). When functioning properly, cells of the immune system will not attack any other cell with markers identifying it as belonging to the body. Conversely, if the immune system cells do not recognize the cell as "self," they attach themselves to it and put out a signal that the body has been invaded, that in turn stimulates the production of substances such as antibodies that engulf and destroy the foreign particles. In case of autoimmune disorders, the immune system cannot distinguish between "self" cells and invader cells. As a result, the same destructive operation is carried out on the body's own cells that would normally be carried out on bacteria, viruses, and other such harmful entities.
The reasons why the immune systems become dysfunctional in this way is not well understood. However, most researchers agree that a combination of genetic, environmental, and hormonal factors play into autoimmunity. Researchers also speculate that certain mechanisms may trigger autoimmunity. First, a substance that is normally restricted to one part of the body, and therefore not usually exposed to the immune system, is released into other areas where it is attacked. Second, the immune system may mistake a component of the body for a similar foreign component. Third, cells of the body may be altered in some way, either by drugs, infection, or some other environmental factor, so that they are no longer recognizable as "self" to the immune system. Fourth, the immune system itself may be damaged, such as by a genetic mutation, and therefore cannot function properly.
Diagnosis
A number of tests that can help diagnose autoimmune diseases; however the principle tool used by doctors is antibody testing. Such tests involve measuring the level of antibodies found in the blood and determining if they react with specific antigens that would give rise to an autoimmune reaction. An elevated amount of antibodies indicates that a humoral immune reaction is occurring. Elevated antibody levels are also seen in common infections. These must be ruled out as the cause for the increased antibody levels. The antibodies can also be typed by class. There are five classes of antibodies and they can be separated in the laboratory. The class IgG is usually associated with autoimmune diseases. Unfortunately, IgG class antibodies are also the main class of antibody seen in normal immune responses. The most useful antibody tests involve introducing the patient's antibodies to samples of his or her own tissue—if antibodies bind to the tissue it is diagnostic for an autoimmune disorder. Antibodies from a person without an autoimmune disorder would not reacting to "self" tissue. The tissues used most frequently in this type of testing are thyroid, stomach, liver, and kidney.
Treatment
Treatment of autoimmune diseases is specific to the disease, and usually concentrates on correction of any major deficiencies. For example, if a gland involved in an autoimmune reaction is not producing a hormone such as insulin, administration of that hormone is required. Administration of a hormone, however, will not restore the function of the gland damaged by the autoimmune disease. The other aspect of treatment is controlling the inflammatory and proliferative nature of the immune response. This is generally accomplished with two types of drugs. Steroid compounds are used to control inflammation. There are many different steroids, each having side effects. The proliferative nature of the immune response is controlled with immunosuppressive drugs. These drugs work by inhibiting the replication of cells and, therefore, also suppress non-immune cells leading to side effects such as anemia.
Prognosis
Prognosis depends upon the pathology of each autoimmune disease, as well as early detection and the ability to put the disease process into remission.
Health care team roles
Health care teams should help patients to understand their illness and treatment plan. With any autoimmune disorder, communication between the patient and doctor is critical, so health care teams should be available to answer questions about the patient's particular condition, especially what changes and symptoms to expect.
Prevention
To date, prevention of many autoimmune disorders is unavailable since the exact causes of the disease are not understood in many cases. Genetic screening of an unborn fetus may be the only method of preventing some autoimmune disorders.
KEY TERMS
Autoantibody—An antibody made by a person that reacts with their own tissues.
Autoimmune disease—A broad category of related diseases in which the person's immune system attacks his or her own tissue.
BOOKS
Benjamini, Eli, Richard Coico, and Geoffrey Sunshine. Immunology: A Short Course. 4th ed. New York: John Wiley & Sons, 2000.
Kendall, Marion D. Dying to Live: How Our Bodies Fight Disease. Cambridge, UK: Cambridge University Press, 1998.
Ravicz, Simone, Ph.D. Thriving With Your Autoimmune Disorder: A Woman's Mind-Body Guide. Oakland, CA: New Harbinger Publications, 2000.
Sompayrac, Lauren M. How the Immune System Works. Oxford: Blackwell Science Inc., 1999.
PERIODICALS
Weetman, A. P. "Medical Progress: Graves' Disease." New England Journal of Medicine 343 (2000): 1236-1248.
ORGANIZATIONS
American Autoimmune Related Diseases Association, Inc. National Office. 22100 Gratiot Ave., Eastpointe, MI48021. (810) 776-3900. <http://www.aarda.org>.
