An Overview of Common Autoimmune Diseases

Could My Body Betray Me?

Did you know that your body can attack itself and lead to sickness? These ‘sicknesses’ are a group of disorders collectively called autoimmune diseases. To have a working knowledge of autoimmune diseases, it's important that we define the following terms first.

Auto – the word prefix auto- means self

Immunity – is a state or condition wherein you're protected from infection or disease. Your body naturally has enough defenses to sustain a healthy state.

Immune System – you need an intact immune system to combat diseases. It's a set of biological structures which protect you from anything which can compromise your health. As an adult, your immune cells are predominantly located in your spleen and bone marrow.

Antigen – is simply any substance that promotes or evokes the production of antibodies. The source of the antigen can be from inside your body or from outside sources.

Antibody – is a protein (immunoglobulin) produced by immune cells, which locates the antigen and attacks it.

Autoantibody – is an antibody produced during the state of autoimmunity. This type of antibody is unable to distinguish between self and non-self antigens. Self antigens are attacked by Autoantibodies when it should actually be the non-self antigens being attacked.

Now that we have defined the preceding terms, let's combine them to fully comprehend the concept of autoimmune diseases. Simply put, autoimmunity means that you're body is no longer efficient at differentiating you (self-antigens) from the enemy (non-self-antigens). Your immune system is puzzled whether the substance in question belongs to you or to the invaders and their by-products (viruses, bacteria, etc.). It's actually a loss of immune tolerance that leads to autoimmunity. Your body can no longer tolerate the self-antigens, so it attacks them. As a result, your body mounts an immune response against you. 111937304

I know, your big question now is, “Why does our own immune system attack us?” Unfortunately, for now, the exact answer to that question is as vague as the answer to the question “Why do we fall in love?”.... There are some theories as to why this happens, autoimmunity okay? Not falling in love. For the record, the exact mechanisms that happen are still not that clearly understood. Below is an overview of some of the prototypical autoimmune diseases we can encounter.

1. Systemic Lupus Erythematosus (SLE). This is the prototype of autoimmune diseases. It's more prevalent in females than in males (9:1 ratio, sorry ladies). Among the general population, the incidence can be up to 1 in every 2500. People with SLE have numerous Autoantibodies which attack self antigens located in various parts of the body. There are anti-nuclear Autoantibodies (these attack the nuclei of cells), antiphospholipid Autoantibodies (they attack the phospholipids found in cell membranes), and Autoantibodies which promote coagulation. This can lead to increased incidence of blockages in the blood vessels leading to stroke and even miscarriages among pregnant women. Some Autoantibodies also attack components of the blood. The tissues or organ systems involved include the skin, joints, central nervous system, cardiovascular system, spleen and lungs. With appropriate treatment and frequent follow-ups, SLE is manageable.

2. Rheumatoid Arthritis (RA). I think most of us are familiar with this one. It's the most common autoimmune disease. It's a severe form of joint destruction. Other organs that can be affected include eyes, nerves, lungs, heart, skin and blood vessels. This means that Autoantibodies are produced and destroy the mentioned body parts. One percent of the entire world is afflicted with this autoimmune disease. Sorry again for this ladies, it has a 3:1 female to male ratio. It usually affects people in their 20's and 30's. Signs and symptoms of RA include symmetrical (left and right) joint involvement. The most commonly affected joints are those of the hands and feet. Sometimes bigger joints can be affected. There are many treatment modalities available to alleviate the symptoms of RA.

3. Hashimoto's Thyroiditis. This autoimmune disorder is one of the most common causes of HYPOthyroidism in the United States. Pesky Autoantibodies attack antigens located on the thyroid. Your thyroid may be asymmetrically enlarged. Females are affected more than males (10:1). It's more prevalent in people between the ages of 45 and 65 years old. What's worrisome is that this autoimmune disorder puts you at risk of having concomitant autoimmune disorders like type 1 diabetes, myasthenia gravis, SLE, etc.

4. Vitiligo. This autoimmune disorder usually presents itself with well demarcated, irregularly shaped patches of skin devoid of pigment (though it can also affect pigment in other areas of the body such as the hair or eye colour). It can present itself in all races, but is especially prevalent among dark skinned individuals (no racism intended here). The most common locations of the patches are around the mouth, around the eyes, wrists, armpits, anal and genital regions. The Autoantibodies are suspected to attack the melanocytes. The melanocytes are cells responsible for the production of melanin (colour of your skin).

5. Diabetes mellitus type 1. This form of diabetes (in contrast to type 2) is characterized as having absolute deficiency of insulin production and secretion. Autoantibodies attack and destroy the cells (beta cells) which are responsible for the production and secretion of insulin. These people are dependent on insulin injections for life, hence the condition may also be called insulin-dependent diabetes mellitus (IDDM). This condition most commonly occurs in childhood and becomes fairly evident during your teen years. It progresses with age.

6. Graves’ Disease. The most common cause of endogenous (from inside you) HYPERthyroidism is Graves’ disease. Your thyroid gland becomes enlarged due to increased activity of the thyroid follicles. Autoantibodies are produced against the receptors (specifically thyroid stimulating hormone receptors) on the surface of the thyroid gland, causing it to become hyperactive. Other signs include Graves’ ophthalmopathy and dermopathy. Connective tissue behind your eyes increases production of extracellular matrix (soft tissue) accompanied by swelling of the eye muscles and infiltration of immune cells.

7. Pernicious Anemia. Vitamin B12 mainly comes from dietary animal products. Before it can be absorbed in the small intestine, it has to be attached to intrinsic factor (IF). IF is produced by the parietal cells found in your stomach. In pernicious anemia, Autoantibodies attack the IF protein and other Autoantibodies can also attack the stomach lining leading to a deficiency of vitamin B12. The lining of the stomach can become atrophic (flattened and basically, useless). Patients (between 40 and 60 years old) are usually unaware they have this insidious disease. Presenting sign is anemia.

8. Crohn's Disease (CD). In the US alone, this disease has annual incidence of 3 per 100,000. It can present at any age, but is more common among teenagers up to the 20s. Females outnumber the males. Light skinned individuals appear to be more commonly affected than dark skinned ones. Autoantibodies activate inflammatory cells which bring about damage to the lining of the small and large intestines. There are patches of lesions with unaffected areas of tissue interspersed (not the entire length of the intestines is affected). Those who suffer from Crohn’s disease (where the colon is affected) have an increased risk of developing colon cancer.

9. Coeliac Disease. Okay, if you're from the United States, it's spelled as celiac disease. Autoantibodies directed at the lining of the small intestine are believed to be the main pathology in this disorder. The Autoantibodies develop from sensitivity to gluten. So when a person with celiac disease ingests food with gluten (even if its just a small amount of gluten), a vicious autoimmune reaction starts, attacking both self-antigens and nonself-antigens. Celiac disease occurs in those who are genetically predisposed to it. This disease is also known as gluten enteropathy or gluten-sensitive enteropathy. The main symptoms of this disease are diarrhea, multiple vitamin deficiencies and weight loss. The diarrhea is characterized as greasy, malodorous, pale and voluminous. It's greasy because of the presence of fat. The most dreaded thing about having celiac disease is your increased risk of having small intestinal cancers (lymphoma and adenocarcinoma).

The autoimmune diseases briefly described above are the more common ones. Currently, there are around 80 recognized autoimmune disorders. As you can see above, the word Autoantibodies marked in red is the one thing each of these conditions has in common, though the types of Autoantibodies of each is different and specific to the condition. The realm of autoimmune diseases is currently an area of focus for researchers. Newer treatment modalities are expected to come out soon. And yes, your body's immune system can betray you. So better take good care of it as much as possible.


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An Overview of Common Autoimmune Diseases

Could My Body Betray Me?

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