Diseases & Conditions

Autoimmune Disorders


Overview, Causes, & Risk Factors

An autoimmune disorder is one in which a person's immune system begins to attack his or her own body. The immune system creates antibodies against its own tissues. Virtually every part of the body is susceptible to an autoimmune disorder. The following are some diseases and conditions that are believed to have an autoimmune component:

  • autoimmune hemolytic anemia, in which the immune system destroys a person's red blood cells
  • autoimmune hepatitis, which causes inflammation of the liver
  • Berger's disease, also known as IgA nephropathy, which causes kidney damage
  • chronic fatigue syndrome, which causes feelings of malaise, or a vague feeling of illness
  • Crohn's disease, which causes inflammation in the bowels
  • dermatomyositis, which affects the skin and muscles
  • fibromyalgia, which causes chronic pain and stiffness in the muscles
  • Graves' disease, which affects the thyroid gland
  • Hashimoto's thyroiditis, which is a chronic inflammation of the thyroid gland
  • idiopathic thrombocytopenia purpura, which causes low platelet counts and interferes with normal blood clotting
  • lichen planus, which affects the skin, eyes, and linings of the mouth and genitals
  • multiple sclerosis, in which the body attacks parts of the nervous system
  • myasthenia gravis, which causes severe muscle weakness
  • psoriasis, which causes skin lesions and itching
  • rheumatic fever, which causes damage to body organs, including the heart, following a strep infection
  • rheumatoid arthritis, in which the body attacks the joints
  • scleroderma, which involves the skin, gut, and other structures
  • Sjogren syndrome, which causes dry eyes and mouth
  • systemic lupus erythematosus, in which the body attacks connective tissue in joints and also in the kidneys
  • type 1 diabetes, a condition in which the individual doesn't produce enough insulin
  • ulcerative colitis, which also causes inflammation in the bowels
  • vitiligo, which causes a decrease in skin pigments
  • What is going on in the body?

    The job of the immune system is to protect the body from foreign substances. It is the immune system that fights off infections caused by bacteria or viruses. Sometimes a person's own tissues may be seen as "foreign" by the immune system. When this happens, the immune system attacks the body itself. This response is known as an autoimmune disorder.

    What are the causes and risks of the condition?

    Some autoimmune disorders, such as psoriasis, run in families and may have a genetic component. Although no one knows for sure what causes an autoimmune response, some triggers have been identified. These triggers, which may bring on a flare-up of the disorder or worsening of symptoms, include the following:

  • aging
  • cancers, such as leukemia
  • hormones
  • medications
  • pregnancy
  • stress
  • sunlight
  • viral infection, such as a cold or flu
  • New research findings suggest that autoimmune disorders may be triggered by a transfer of cells between the fetus and the mother during pregnancy. The study involved women with scleroderma, an autoimmune disorder involving the skin. These women have more fetal cells in their blood decades after a pregnancy than women who don't have scleroderma. While further research is needed to substantiate these findings, the study does offer an explanation for the much higher incidence of autoimmune disorders in women than in men.


    Symptoms & Signs

    What are the signs and symptoms of the condition?

    The symptoms of an autoimmune disorder depend on the specific disease and the organ or tissue that is affected. For example, systemic lupus erythematosus may cause kidney failure, arthritis, and a skin rash on the face. Autoimmune hemolytic anemia causes anemia, or low red blood cell counts. General symptoms of autoimmune disorders may include:

  • low-grade fever
  • malaise, which is a vague feeling of illness
  • fatigue, or tiring easily

  • Diagnosis & Tests

    How is the condition diagnosed?

    Many autoimmune disorders are diagnosed based on symptoms, a physical exam, and the results of blood tests. These diseases can be difficult to diagnose, especially early on. Sometimes the symptoms of one disease overlap with those of another. In these cases, an overlap or "mixed" disease may be present.

    Some autoimmune disorders need other tests to make the diagnosis. A biopsy sample, or small piece of tissue, can be removed from an affected area. This tissue can then be tested and examined in the lab. A biopsy sample can be taken from almost any part of the body, including the skin, kidney, liver, or intestines.

    Special X-ray tests may need to be done. For example, changes in the joints seen on joint X-rays can help make the diagnosis of rheumatoid arthritis in some cases.


    Prevention & Expectations

    What can be done to prevent the condition?

    No ways are known to prevent autoimmune disorders. Avoiding the triggers can help prevent symptoms from getting worse.

    What are the long-term effects of the condition?

    The long-term effects vary with each disorder. Long-term effects of these disorders include destruction of tissue or a function loss in part of the body. For example, kidney failure is a fairly common problem in persons with severe systemic lupus erythematosus. Those with severe rheumatoid arthritis may not be able to tie their shoes due to the damage in the joints of their hands. Many persons with autoimmune disorders are also at a higher risk of infections.

    Autoimmune disorders are often long-term. The courses they take are hard to predict. In severe cases, serious disability and death can occur.

    What are the risks to others?

    Autoimmune disorders are not contagious and pose no risk to others.


    Treatment & Monitoring

    What are the treatments for the condition?

    The goal of treatment in autoimmune disorders is to reduce symptoms and prevent damage to the organs in the body. This is done by controlling the immune system and the inflammation that it causes. Many of the medications used to treat autoimmune disorders suppress the immune system. That is, they keep the immune system from attacking the body. However, this also reduces the body's ability to fight off infections.

    Treatments to reduce symptoms may include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin or ibuprofen, to relieve fever, joint pain, and muscle aches
  • corticosteroids, or steroids, help reduce inflammation. These medications are often used on a short-term basis to get a person through a sudden episode or flare-up.
  • medications to suppress the immune system, such as methotrexate, azathioprine, and cyclophosphamide, which help to reduce inflammation and organ damage
  • In some cases, other treatments may be needed. For example, surgery may be needed for blockage of the bowels, which may occur in Crohn's disease. Blood transfusions may be needed in severe cases of autoimmune hemolytic anemia. Insulin is given to individuals with type 1 diabetes to control blood glucose levels.

    Many research studies are currently under way to develop or test treatments for autoimmune disorders. These studies include:

  • examining the role of interferon in selected disorders. Beta interferon, for example, has been approved for the treatment of multiple sclerosis and is being tested in other autoimmune disorders as well.
  • studying the use of stem cells, which are a type of cell that can grow into different cell types
  • using new antibodies to modify the way T cells encourage the body to attack its own tissues
  • Although autoimmune disorders cannot be cured, there are steps an individual can take to improve his or her quality of life. These steps include the following:

  • understanding and following the treatment plan developed in conjunction with the healthcare provider
  • avoiding, whenever feasible, triggers such as sunlight or viral infections
  • identifying stressors and using stress-management techniques to lower his or her stress level
  • balancing the need for activity, rest, and sleep
  • eating a healthy diet, as recommended by the healthcare provider. If no special diet is recommended, individuals should follow the food guide pyramid.
  • joining a support group for a specific disorder, such as chronic fatigue syndrome
  • What are the side effects of the treatments?

    Medications used to treat autoimmune disorders have many side effects. The side effects include:

  • stomach upset, stomach bleeding, headaches, and a decrease in kidney function caused by NSAIDs
  • weight gain, high blood pressure, acne, easy bruising, bone loss known as osteoporosis, increased blood glucose, an increased risk of infection, and muscle weakness, which may be caused by corticosteroids
  • an increased risk of infection, stomach upset, and liver or kidney damage which may be caused by medications that suppress the immune system
  • Surgery carries a risk of bleeding, infection, and allergic reaction to anesthesia. Blood transfusions carry a risk of allergic reactions and infections.

    What happens after treatment for the condition?

    Autoimmune disorders are often long-term diseases with symptoms that can come and go over time. The outcome varies with each disorder. Many can be controlled with treatment. A person may need treatment for the rest of his or her life. Specific treatments are often related to the body damage that occurs.

    How is the condition monitored?

    A person with an autoimmune disorder should have frequent physical exams. This helps the healthcare provider monitor the disorder and watch for complications. Frequent blood tests may help monitor the disorder as well. Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:Gail Hendrickson, RN, BS
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:08/28/01
    Reviewer:Adam Brochert, MD
    Date Reviewed:08/28/01

    Sources

    "Understanding Autoimmune Disorders", www.niaid.nih.gov/publications/autoimmune.htm

    The Merck Manual of Medical Information, Home edition, 1997

    Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998

    Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000