Autoimmune Diseases

By Philip R. Hardy, MD

Autoimmune Diseases Article by Dr. Hardy

Autoimmune diseases now currently number into the hundreds these days, and the extent to which they are responsible for multiple disorders is just beginning known.

Rheumatoid Arthritis

The classic autoimmune disease that presents with involvement of the musculoskeletal system is Rheumatoid Arthritis. This syndrome has several different manifestations.  Beginning with Juvenile Rheumatoid Arthritis in the youngest patients.  Presenting as “Pauciarticular Rheumatoid Arthritis” in patients in their teens to thirties.  Lastly, as RA in the more widely recognized variety which occurs commonly in the middle-aged to the elderly. Therefore, RA affects a large area of the population.

The Immune System

The one factor that all autoimmune diseases have in common is the body’s own defense mechanism.  The immune system, which starts to attack the body’s own tissues, beginning with an inflammatory phase.  If left unchecked, can lead to the overt destruction of joints and other tissues.  Leaving the joint a mere remnant of their previous forms, often without function. Awareness of autoimmune diseases is critically important because there are disease-modifying agents available today.  These agents can alter the course of the maladies and provide the patient with enhanced quality of life.

Musculoskeletal Autoimmune Diseases

The two main groups of autoimmune diseases affect the musculoskeletal system. The “seropositive” type, where the test for Rheumatoid Arthritis is positive, and the “seronegative” types, commonly called seronegative spondyloarthropathies. In other words, this means that the blood test for Rheumatoid Arthritis is negative.  The areas involved include the spine and the joints. There are some tests, such as the HLA-B27, which show this to be present in a much higher percentage of patients with Ankylosing Spondylitis than in the normal population.

Psoriasis

The skin disease Psoriasis is now know to be an autoimmune. It has been known for many years, however, that patients with Psoriasis can develop joint involvement.  This is often characterized by stiffness, ankylosis, fibrous or a boney fusion.

Other Diseases

Other diseases, such as Inflammatory Bowel Disease, Systemic Lupus Erythematosus (Lupus), Sjogren’s disease, Scleroderma, and Reiter’s Disease are autoimmune and are arthritic in nature to the joints of the body.
The cause of many of these disorders turns out to be a genetic predisposition, plus other environmental factors. Reiter’s Disease, for example is also known as ‘Reactive Arthritis’ and has been shown to be associated with a chronic infection by an organism called Chlamydia. In common with many of these maladies, chronic infections start the immune system along the path toward the production of antibodies.  The genetic predisposition allows these antibodies to attack the patient’s own tissues. This is one of the few diseases which has identifies the agent or the cause of the disease.

Treatment of Autoimmune Diseases

Once the inflammatory process starts, there are several ways of dealing with it. The typical “non-steroidal anti-inflammatory” agents, of which aspirin was the first, have been used extensively.  As have steroid anti-inflammatory agents such as prednisone. Anti-metabolic agents, such as methotrexate are also used, especially in Rheumatoid Arthritis.

Medications

The new, more specific agents or so called “anti-tumor necrosis factor alpha agents,” such as Enbrel, or Humira, are common medications. They belong to the disease-modifying anti-rheumatic drugs (DMARDs). DMARDs can really enhance the quality of life of patients with these diseases. These agents are really antibodies themselves that target the antibodies in production by the patient. These antibodies are the ones causing tissue destruction. The problem of using one set of antibodies to tackle a different set is that, on occasion, the body’s own immune system starts to produce even newer antibodies against the treatment antibodies.  Thus, the treating agents are unfortunately rendered ineffective. To add even more confusion, there have been cases of patients in treatment for Ankylosing Spondylitis with these agents who develop Psoriasis as a side effect of the treatment.

Conclusion

In conclusion, the bottom line is that if a patient has any autoimmune disease, he or she may be more likely to get another. In the presence of vague, multi-organ system symptoms, characterized by stiffness after periods of inactivity should be a sign.  Another sign is a family history of any autoimmune disease. Therefore, this should immediately alert the physician to the possibility that the patient’s problem could easily be another variety of such a disease

JOI Fracture and Injury Care

JOI Physicians are currently offering ASAP Fracture care. Make an appointment by calling (904) JOI-2000. This is a new option for patients who would like to avoid the emergency room if they have suffered a fracture or soft tissue injury. Therefore, to learn more about this service, read this article about fracture and injury care.

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