You probably hear people talking about autoimmune diseases a lot these days—and that’s because there’s much more awareness around the millions of Americans who live with them. In fact, they’re a leading cause of death in young and middle-aged women, according to research published in the The American Journal of Public Health.
Understanding autoimmune diseases isn’t easy, though—especially since they’re not all common (and there are over 100 of them!), many aren’t well-researched, and some of the diseases (such as rheumatoid arthritis or ankylosing spondylitis) don’t look anything like others (such as psoriasis, lupus, or type 1 diabetes).
At the core of every autoimmune disease is inflammation—which is why the terminology “autoimmune diseases” is sometimes used interchangeably with “autoinflammatory diseases.” There is a slight difference between the two, however, which is identified by the underlying cause of the disease. In short, autoinflammatory diseases are thought to stem from a malfunction in the innate immune system (which attacks antigens immediately and without a specific course of attack), whereas autoimmune diseases are thought to stem from a malfunction in the adaptive immune system (which reacts to specific antigens with specific courses of attack).
Fortunately, more and more research is being done around inflammation’s massive effects on our health.
The Deal With Inflammation
Quick science lesson: We all have immune systems—they keep us healthy by shielding our bodies from diseases and infections. When your body comes into contact with harm, your immune system sends out its troops (a.k.a. our white blood cells), which rush to surround the effected area. This is called acute inflammation.
So, does that mean inflammation is a good thing? Yes and no. Although acute inflammation is necessary for our health, its bad rap isn’t entirely undeserved. In the case of people with autoimmune diseases, the issue is chronic inflammation.
“Autoimmune diseases arise when the immune system is triggered to produce antibodies [inflammation], which, rather than defending the body, instead begin attacking the body’s tissues,” says Hospital for Special Surgery rheumatologist Medha Barbhaiya, MD. It’s sort of akin to going into battle when there is no enemy. Those inflammatory responses create diseases that affect many parts of our bodies (everything from our eyes to our joints to our kidneys and hearts).
The diseases are all different and require varying modes of treatment, depending on the disease itself, the person, and the symptoms.
Why do people have autoimmune diseases?
Unfortunately, there’s no hard and fast answer. “Extensive research efforts are currently being dedicated to identifying potential underlying mechanisms that trigger such an abnormal response of the immune system,” says Dr. Barbhaiya.
According to the National Institutes of Health (NIH), 23 million Americans suffer from an autoimmune disease. However, statistics from the American Autoimmune Related Diseases Association put that number at around 50 million. What gives? “While we do not know why the prevalence is so high, both hereditary and environment-lifestyle factors may play an important role in determining who develops an autoimmune disease,” says Dr. Barbhaiya. “In fact, the current disease paradigm being investigated is one of a ‘two-hit’ hypothesis, suggesting that an environmental and lifestyle exposure may trigger disease in those with an underlying genetic predisposition.”
According to Dr. Kimberly Sanders, a licensed Naturopathic Physician at Arthrowell, some of those lifestyle and environmental triggers may include ”poor digestion, digestive tract infections, blood infections, toxins, hormone imbalances, stress, and more.” Sanders says that the accumulation of all of these triggers is enough to set a person’s disease-carrying genes off—leading to symptoms.
Could you have an autoimmune disease?
The short answer: It’s hard to know. If you think understanding the reason why people get autoimmune disease is complicated, you should know that getting a proper diagnosis isn’t always easy either.
According to an article published by the University of Virginia, many people—including some doctors—downplay autoimmune disease pain or symptoms. In fact, plenty of people with autoimmune disease convince themselves that what they’re experiencing is “all in their heads”. On top of that, it’s common to have a few autoimmune disease at the same time. And some people’s autoimmune diseases masquerade as other illnesses and are misdiagnosed.
According to the NIH, the classic physical sign is inflammation, which can present as pain, swelling joint pain, digestive issues, fatigue, or recurring fever. The problem? This might seem like the flu, or general muscle aches, or simply feeling run down. People with autoimmune diseases may also experience unpredictable flare-up periods and total remission periods.
To further complicate things, most autoimmune disease don’t have reliable screening tests, Dr. Barbhaiya explains. This means that by the time the sickness disrupts your lifestyle, you wouldn’t even know it was there. “What complicates things further is that there is a subset of the population who may test positive for certain disease-specific antibodies, but never actually go on to develop any clinical manifestations,” Dr. Barbhaiya says.
If you do have a family history of autoimmune disease or suspect that something isn’t right—like you’ve had joint pain and fatigue for months—see your primary care physician first, and ask for a referral to a rheumatologist.
Dr. Sanders also suggests you find a “naturopathic autoimmune expert to run blood tests and catch the early expression of autoimmune diseases.” While many doctors treat the symptoms, it’s important to seek the cause or root of the issue—and see a doctor who practices functional medicine, which addresses the underlying causes.
Is there a cure?
There is no official cure for autoimmune diseases and each disease must be treated differently, but doctors may prescribe medications like corticosteroids, NSAIDS, biologics, immunosuppressants, and chemotherapy. In some cases, as with lupus, kidney transplants have been necessary.
Additionally, supplements, diets, exercise, stress-reduction techniques, and physical therapy can help people manage their symptoms. There is evidence, for example, that some diets are beneficial to people with certain autoimmune diseases, according to an article published in Current Allergy and Asthma Reports. Other autoimmune diseases may benefit from certain types of exercise.
“There is much work to be done to better understand the underlying biology and risk factors for autoimmune diseases in order to improve prevention strategies and ultimately help find a cure,” says Dr. Barbhaiya.