There is a dark side to our immune system. It is supposed to fight invaders to keep us healthy. But sometimes it becomes a traitor and attacks our own cells and tissues.
What are called autoimmune diseases can affect almost every part of the body and tens of millions of people. meanwhile most common in womenthese diseases can affect anyone, both adults and children, and are on the rise.
New research raises the possibility of developing treatments that go beyond just suppressing symptoms. Dozens of clinical trials are testing ways to reprogram malfunctioning immune systems, with some early promising successes. against lupusmyositis and certain other diseases. Other researchers are exploring ways to at least delay the onset of the autoimmune disease with drugs that can buy time before symptoms of type 1 diabetes appear.
“This is probably the most exciting time ever for autoimmunity,” said Dr. Amit Saxena, a rheumatologist at New York University Langone Health.
Here are some things you should know.
What is an autoimmune disease?
These are chronic diseases that can range from mild to life-threatening, and there are more than 100 diseases that have different names depending on how and where they are injured. Rheumatoid arthritis and psoriatic arthritis attack the joints. Sjögren’s disease is known for dry eyes and mouth. Myositis and myasthenia gravis weaken muscles in different ways, the latter by attacking signal transmission from nerves. Lupus has a wide range of symptoms, including a butterfly-shaped facial rash, joint and muscle pain, fever, and damage to the kidneys, lungs, and heart.
Also, there are some quirks. Patients who have been well for a long time may suddenly have a “flare-up” for no apparent reason.
Why diagnosing autoimmune diseases is so difficult
Many begin with vague symptoms that come and go or resemble other illnesses. Often there are also overlapping symptoms. For example, rheumatoid arthritis and Sjögren’s syndrome can also damage major organs.
Diagnosis may require multiple tests, including blood tests to detect antibodies that accidentally attach to healthy tissue. Usually, we focus on the symptoms and rule out other causes. For some illnesses, it can take years and multiple doctor visits to find clues. Improvement efforts are underway. The National MS Society is educating physicians about newly updated guidelines to streamline multiple sclerosis diagnosis.
How does the immune system become abnormal?
The human immune system is a complex army of sentinels that detect threats such as bacteria and cancer cells, various soldiers who attack them, and peacemakers who calm things down after the danger has passed. The important thing is to be able to distinguish “you” from foreign objects, which scientists call tolerance.
Disorganized immune cells and antibodies can slip through, and peacekeepers can fail to calm the situation after a battle. If the system is unable to detect and resolve the problem, autoimmune diseases develop gradually.
Autoimmune diseases are often caused by triggers
Most autoimmune diseases, especially in adults, are not caused by a specific genetic defect. Rather, different genes that affect immune function may make people more susceptible to infection. Scientists say the disease requires an “environmental” trigger, such as an infection, smoking or pollutants, to develop. for example, Epstein-Barr virus is associated with MS.
Scientists are focusing on the earliest molecular triggers. For example, white blood cells called neutrophils are the first to respond to signs of infection or injury, and abnormally overactive white blood cells are suspected of playing a key role in lupus, rheumatoid arthritis, and other diseases.
Women are most at risk for autoimmune diseases
Four out of five autoimmune patients are women, many of whom are young. It is thought that hormones are involved. But women also have two X chromosomes, and men have one X and one Y. Some research suggests that there is an abnormality in the way a woman’s cells turn off that extra X chromosome, which may make her more vulnerable.
But men also suffer from autoimmune diseases. A particularly severe condition called VEXAS syndrome wasn’t discovered until 2020. It primarily affects men over the age of 50 and can cause blood clots, shortness of breath, and night sweats, in addition to typical autoimmune symptoms.
Certain populations are at increased risk. For example, lupus is more common in black and Hispanic women. Northern Europeans are at higher risk for MS than other groups.
Treatment of autoimmune diseases is complex
According to investment research firm Morningstar, the global market for autoimmune disease treatments is worth $100 billion annually. This does not include things like doctor visits or time lost at work. Treatment is lifelong and is usually covered by insurance, but it can be expensive.
Not so long ago, there were few treatments for many autoimmune diseases other than high-dose steroids and broad-spectrum immunosuppressants, which came with side effects including the risk of infection and cancer. Some new options now target specific molecules, making immunity somewhat less compromised. However, for many autoimmune diseases, treatment is a trial-and-error process with little to guide patient decision-making.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. AP is solely responsible for all content.
