The enemy within

While the immune system is the body’s defence mechanism that helps to protect it against disease and infections, sometimes, due to some changes, the ability to differentiate between self and foreign bodies is lost and the immune system begins to attack the body itself. These types of diseases are called autoimmune diseases and are best dealt by a rheumatologist, explains Dr H. R. Madhuri, consultant rheumatologist, CARE Hospitals.

“In an autoimmune disease, the immune system mistakes parts of your body, like your joints or skin, as foreign. It releases proteins called auto-antibodies that attack healthy cells. Some autoimmune diseases target only one organ. Type 1 diabetes, for instance, damages the pancreas. Other diseases, like systemic lupus erythematosus (SLE), affect the whole body. Based on where the body is affected, there can be different symptoms,” says Dr Madhuri.

However, since these diseases commonly affect the joints, the umbrella term ‘arthritis’ may refer to autoimmune diseases, which come under the purview of a rheumatologist.  “Most rheumatologic diseases commonly affect women more than men. Given that age and gender are not immune from these conditions, children may also be affected. There may be a genetic component in some diseases, so a history of a family member suffering from similar complaints is an important clue to the diagnosis. Certain autoimmune diseases, like multiple sclerosis and lupus, run in families. Not every family member will necessarily have the disease, but they inherit a susceptibility to an autoimmune condition,” says Dr Madhuri.

SYMPTOMS
Since the women affected are mostly young women in their childbearing years, a time when they are traditionally most healthy, getting a diagnosis can prove to be extremely difficult. Symptoms vary widely, notably from one illness to another and even within the same disease. And because the diseases affect multiple body systems, their symptoms are often misleading, which hinders accurate diagnosis. A rheumatologist is a physician who has undergone further specialised training in the management of diseases related to bones, joints, soft tissues and autoimmunity.

“Common symptoms to look out for are recurrent fevers, fatigue, loss of appetite, loss of weight, mouth ulcers, skin rashes, photosensitivity, joint pains with swelling. Specific organ symptoms may include bleeding due to low platelet counts, tiredness due to low haemoglobin, chest pain, breathlessness, cough, neurological symptoms like numbness, muscle weakness, seizures, loss of consciousness and kidney problems which are generally detected on investigation,” she explains.

Some of the more common autoimmune diseases are rheumatoid arthritis, lupus, systemic sclerosis, Sjogrens syndrome, mixed connective tissue disease, vasculitis, dermatomyositis, and sarcoidosis. “Some specific type of investigations like rheumatoid factor, ANA, dsDNA, x-rays or CT scans may be asked for depending on the severity of the disease. Treatment is then accordingly adjusted,” adds Dr Madhuri.

MEDICATION
Medicines include steroids and immune suppressants like methotrexate, azathioprine, cyclophosphamide and mycophenolate mofetil along with some latest injections called biologics. These are powerful drugs and need to be used under careful monitoring by a physician only. Regular review and blood tests are required for proper management. Pregnancy is a special scenario which may require adjustment of medicines.

HEALTHY LIFESTYLE
Maintaining proper weight, having fresh fruits and vegetables, adequate vitamin D levels, avoiding fast foods, smoking and alcohol, regular exercise and stress management are equally important in managing these conditions. Sometimes, exercises may need to be done under the guidance of a physiotherapist.

Awareness is the most important step as early diagnosis and treatment prevent complications and make these autoimmune conditions easier to manage.