The names might sound familiar: Rheumatoid arthritis, type 1 diabetes, multiple sclerosis, lupus and scleroderma.
Autoimmune diseases affect an estimated 24 million people in the U.S. These chronic and disabling disorders—more than 80 and counting—develop when one or more of our immune systems mistakenly attack cells, tissues and organs instead of protecting the body. Problems can also arise when our immune systems fail to manage the interactions of our body’s many organ systems, from respiratory to reproduction.
The debilitating and long-term nature of these complex disorders can significantly decrease patients’ quality of life and ability to work. The stress of these illnesses is often a big burden on families.
Autoimmunity appears to be increasing in the United States and in many parts of the world. In the wake of the COVID-19 pandemic, new studies indicate that SARS-CoV-2 infections might be linked to a substantially increased risk of developing a range of autoimmune diseases, including rheumatoid arthritis, vasculitis and inflammatory bowel disease.
How does our immune system work?
Our immune system is a complex network of cells, proteins, tissues and organs with the critical task of helping to keep us well and alive. We have three types of immunity. The first of these is the innate or “natural” immunity we are born with that provides general protection against “outsiders” such as bacteria or viruses. As we age, we develop “adaptive” immunity when we are exposed to diseases or get vaccinations. Lastly, we can acquire short-term “passive” immunity from another source like a mother’s breast milk that protects a baby against germs or diseases to which its mother has been exposed.
What causes autoimmune illnesses?
The exact cause of autoimmune diseases is not well understood, but the immune system is involved in every aspect of human anatomy and physiology, so its malfunction can target any organ and system in the body.
There are risk factors that research suggests can increase the chances of developing one of these diseases. Genetics, sex, race and ethnicity and the environment appear to play a role. For example, having relatives with an autoimmune illness increases a person’s risk. Also, if someone already has an autoimmune disorder, it increases the chance they will develop another one.
Researchers studying the rise of autoimmune conditions around the world have also found evidence that some chemicals, such as organic pollutants, toxic metals and certain solvents, could play a role.
Who is more at risk for developing an autoimmune disorder?
Women are significantly more susceptible to developing an autoimmune illness, although some disorders are more common in men. Lupus, which can cause chronic pain and inflammation throughout the body—including the joints, skin, heart and other organ systems—is far more common in women. However, ankylosing spondylitis, a disorder that causes bones in the spine to fuse over time, is more common in men. Type 1 diabetes and Crohn’s disease (chronic inflammation of the digestive tract) occur at about the same rate in men and women.
The precise cause of the sex differences in autoimmunity is not completely understood. Studies suggest genetics and hormones play a key role. Being obese or having a prior infection or exposure to toxins also may elevate the risk of a breakdown in the immune system.
Race and ethnicity appear to contribute to the risk for developing autoimmune disorders as well. Cedars-Sinai investigators have found that people of Ashkenazi Jewish descent develop Crohn’s disease at higher-than-average rates. Black women face a higher risk for developing lupus than people of European ancestry. African American and Hispanic patients with scleroderma—an autoimmune disease characterized by thickening and scarring of the skin and vital organs and the narrowing of the blood vessels—develop more severe forms of the illness and have a higher death rate from the disorder.
What are symptoms of autoimmune diseases, and how do I get diagnosed?
There are very few specific tests for autoimmune diseases. Common symptoms of autoimmunity such as fatigue, joint pain, intestinal problems, swollen glands and recurring fevers can be associated with other conditions. The best suggestion is to find a medical center that has specialists and specialty clinics focused on the diagnosis and treatment of autoimmune disorders. Getting answers can require detective work, so it is important to find a clinician who will partner with you in the journey to find a diagnosis and effective treatment.
Dr. Francesco Boin is the Chair of Rheumatology and Director of the Cedars-Sinai Kao Multispecialty Scleroderma Program. His research focuses on the genetic risk of scleroderma and the biology of immune cells involved in the development of this disease. Dr. Boin uses his clinical work with patients to help design studies targeting the most important questions about scleroderma.
Dr. Nunzio Bottini is the Founding Director of the Cedars-Sinai Kao Autoimmunity Institute and a practicing rheumatologist. His research to improve and develop effective therapies for patients involves the investigation of genetic mechanisms that may put people at risk for developing rheumatoid arthritis, type 1 diabetes, inflammatory bowel disease and lupus.