Common Autoimmune Conditions

Autoimmune diseases occur when the body can’t recognize the difference between itself and other types of cells. The body makes antibody proteins that cause it to attack itself. Autoimmune diseases can affect any part of the body, and some diseases attack multiple parts of the body at once. There are more than 80 different autoimmune diseases. Some of them are common while others are more rare.

Celiac disease

Celiac disease is a chronic autoimmune disorder that causes digestive and intestinal problems. It is triggered by foods that contain gluten, a protein found in wheat, barley, and rye. Gluten can be found in many foods as well as many other products such as cosmetics, personal care products, and supplements. This autoimmune disease occurs in around 1% of people worldwide.

Celiac disease can affect the intestines as well as other parts of the body. Diarrhea, fatigue, weight loss, bloating, abdominal pain, nausea and vomiting, anemia, osteoporosis, mouth ulcers, joint pain, and other symptoms are all associated with celiac disease.

The primary and only effective treatment for celiac disease is a gluten-free diet for life. This requires strict avoidance of all foods that contain gluten including wheat, barley, and rye. It also requires strict avoidance of gluten in other foods such as some types of oatmeal and soy sauce. Reading labels is extremely important for patients with celiac disease because gluten is present in more foods than you think either directly or through cross-contamination. Refractory cases, up to 20% of patients, may require immune suppressive medications.

Patients with celiac disease may need more frequent follow-up and evaluation for other conditions associated with celiac such as thyroid disease and osteoporosis. You may also need mineral or vitamin supplementation to help with malnutrition associated with poor nutrient absorption.

Graves’ disease

Graves’ disease is an autoimmune thyroid disorder that can cause hyperthyroidism in its early stages. The thyroid is responsible for metabolism in the body affecting every body system. Graves’ disease is present in about 1% of people worldwide and is the cause of about 80% of cases of hyperthyroidism.

Graves disease can cause weight loss, rapid or irregular heart rate, nervousness, irritability, insomnia, fatigue, weakness, shaking, diarrhea, or an enlarged thyroid gland that appears as neck swelling. It can also cause thyroid eye disease. The eyes can bulge, have blurry or double vision, be gritty or irritated, have pressure, or be painful.

Graves is treated with medication such as steroids or anti-thyroid medications. It may also be treated with ablation or destruction of the thyroid gland or surgery. If the thyroid has been removed, you may need thyroid replacement medications.

Hashimoto’s thyroiditis

Hashimoto’s thyroiditis is another common type of autoimmune thyroid disease. It is more commonly associated with hypothyroidism though it can sometimes cause hyperthyroidism. Hashimoto’s is the most common cause of hypothyroidism and is present in about 5% of Americans. It is much more common in women than men.

Symptoms include fatigue, weight gain, cold intolerance, joint and muscle pain, constipation, dry skin, thinning hair, irregular menses, and low heart rate. There can be enlargement of the thyroid gland early on in the course of the disease, but as the thyroid gland is damaged, the gland can shrink and disappear.

Hashimoto’s’ disease is associated with other autoimmune diseases. Celiac disease is 5 times more common in patients with Hashimoto’s than in the general population. It is usually treated with thyroid replacement medication.

Type 1 diabetes

Type 1 diabetes is another common autoimmune disease. The body’s immune malfunctions and starts attacking the pancreas destroying the insulin-producing beta cells. People with family members with type 1 diabetes are 15 times more likely than the general population to develop type 1 diabetes, but most people diagnosed with type 1 diabetes do not have a family history. Type 1 diabetics frequently present, for the first time, very sick with a condition called diabetic ketoacidosis or DKA. Fruity-smelling breath, abdominal pain, increased thirst, and increased urination are common symptoms that precede DKA. Treatment for type 1 diabetes is insulin. Insulin comes in long-acting and short-acting forms. Type 1 diabetes can cause long-term health risks including the risk of kidney damage, blood vessel disease, strokes, heart attacks, and eye disease. Tight control of diabetes is important for preventing these complications.

Lichen sclerosis

Lichen sclerosis affects the mucus membranes. It most commonly occurs in the genital area but can occur in other areas as well. It is more common in women but does occur in men as well. It can cause scarring of the affected areas. The exact cause of lichen sclerosis is unknown, but it is believed to be autoimmune. It affects 1 in 300 to 1 in 1,000 people. It is thought to be underdiagnosed because it is frequently misdiagnosed and many people with the disease don’t have symptoms.

Symptoms of lichen sclerosis are decreased pigmentation and thinning of the skin in the affected area. It frequently causes itching or discomfort in the skin. Treatment for this disease is usually high-potency topical steroids. In men with the disease, circumcision may be recommended to try to prevent inflammation and scarring of the foreskin.

Lupus

Lupus is an autoimmune disease that attacks multiple systems in the body. It can affect the skin, joints, heart, lungs, kidneys, blood cells, and brain. The symptoms vary significantly between affected people. It can cause you to have arthritis with painful joints and stiffness, fevers, fatigue, rashes, hair loss, sores, and swelling of the face, legs, and glands. This disease affects 20-150 people in every 100,000 in the United States.

Lupus can cause kidney damage, seizures, heart problems, blood clots, low blood counts, and inflammation around the lungs causing pain with breathing. Lupus can be treated with anti-inflammatories, antimalarials, steroid medications, or other immunosuppressant medications. Lupus is most commonly treated by rheumatologists, doctors who specialize in certain types of inflammatory autoimmune disorders.

Meniere’s disease

Meniere’s disease affects about 0.2% of the United States population. About one-third of Meniere's disease cases are autoimmune. Meniere’s disease is associated with dizzy spells, ringing in the ears, and hearing loss. It can cause severe vertigo. The cause of Meniere’s disease is not well understood. This disease can be treated with medication, salt restriction, some types of therapy, and injections. In severe cases, surgery to decompress the endolymphatic sac in the ear or the vestibular nerve can be used to treat symptoms.

Multiple sclerosis

Multiple sclerosis is an autoimmune inflammatory condition that affects the nervous system. This condition causes loss of the myelin sheath around the nerves and can cause the nerves themselves to degenerate. It is associated with other autoimmune conditions. The incidence of multiple sclerosis is about 1 in 333.

Multiple sclerosis can cause pain, weakness, and loss of independence. The symptoms can vary widely between patients and even over time. By definition, the lesions associated with multiple sclerosis are separated by distance and time. Because different parts of the nervous are affected, the symptoms will depend on what part of the brain or spinal cord is degenerating. There is no cure for multiple sclerosis. Medications for multiple sclerosis focus on decreasing the frequency and severity of the flairs.

Psoriasis/psoriatic arthritis

Psoriasis is a chronic autoimmune disease that affects the skin and sometimes the joints. Psoriasis is associated with an increased risk of heart attack, stroke, arthritis, mental health concerns, some cancers, and other autoimmune diseases. It affects about 2-3% of the world population and about 3% of the United States population.

Psoriasis causes red patches with silver-white scales. It can also cause small pus-filled bumps. It usually happens on the elbows, knees, scalp, or trunk. It can also happen in the skin folds. Psoriatic arthritis causes severe joint pain, stiffness, and swelling. In some cases, eye inflammation can be associated with psoriasis.

There is no cure for psoriasis or psoriatic arthritis and medication is aimed at decreasing the symptoms and preventing damage to joints. Skin symptoms can be treated with phototherapy using certain types of ultraviolet light or topical medications that can be applied to the skin. If you have severe psoriasis or psoriatic arthritis, oral or injected medications may be recommended by your doctor.

Raynaud’s phenomenon

Raynaud’s phenomenon is a condition that is frequently associated with other autoimmune diseases. It causes inappropriately restricted blood flow to the extremities. It most often affects the fingers and toes but can also affect the ears and nose. It usually occurs in response to sudden changes in temperature and emotional stress.

Raynaud’s can be primary or from unknown cause or can be secondary to other autoimmune conditions you might have such as lupus or scleroderma.

In Raynaud’s, the affected areas turn white, blue, or red. They can become extremely painful. In severe cases, the lack of blood flow can cause painful sores or gangrene.

Treatment of Raynaud’s usually involves trigger avoidance. In some cases, medications may be used to try to control the restriction of blood flow and improve circulation.

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Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine, including obstetrics, women’s health, and endoscopy, as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.

References:

1. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease
2. https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease#:~:text=Graves'%20disease%20is%20an%20autoimmune,the%20way%20your%20heart%20beats.
3. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease
4. https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes
5. https://www.ncbi.nlm.nih.gov/books/NBK538246/#:~:text=LS%20is%20a%20mucocutaneous%20autoimmune,scarring%20of%20the%20vaginal%20introitus.
6. https://www.niams.nih.gov/health-topics/lupus#:~:text=Lupus%20occurs%20when%20the%20immune,circulating%20blood%20cells%2C%20and%20brain.
7. https://www.mayoclinic.org/diseases-conditions/menieres-disease/symptoms-causes/syc-20374910#:~:text=Meniere's%20disease%20is%20an%20inner,ages%20of%2040%20to%2060.
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9123335/#:~:text=Multiple%20sclerosis%20(MS)%20is%20an,varying%20degrees%20of%20axonal%20loss.
9. https://www.niams.nih.gov/health-topics/psoriasis#:~:text=Overview%20of%20Psoriasis,can%20be%20affected%20as%20well.
10. https://www.niams.nih.gov/health-topics/raynauds-phenomenon