When Your body Screams No!

When your immune system turn on itself, there is a war within the body. Stay safe and on the top of auto-immune disorders with this valuable users guide.

What if a police officer attacks you instead of protecting you? Or if, instead of getting the bad guys, he decides to put you behind bars?

This is exactly what happens when your body's immune system mistakenly turns on your own healthy organs and attacks them, resulting in autoimmune disorders. When the attack is on a single organ system such diseases are called 'organ-specific' autoimmune diseases (e.g., type 1 diabetes), whereas when the attack is more widespread and affects many organs the diseases are termed as 'systemic' autoimmune diseases (e.g. rheumatoid arthritis). Your immune system may also react to a foreign substance that it normally would ignore (akin to a cop arresting an infant) resulting in an immune reaction commonly termed as an 'allergy'. Here are some major autoimmune disorders and how to cope with them.

LUPUS
Diagnosing this disorder can be complicated as Systemic Lupus Erythematosus (SLE) symptoms tend to vary from patient to patient, are unpredictable, and follow an up and down course.

THE DISORDER
Lupus is a chronic inflammatory disease wherein your body's immune system attacks various organs including the joints, skin, kidneys, blood cells, heart and lungs, making it a potentially life-threatening illness. "While lupus is quite rare (affects 1 in 40,000 people), it is a dramatic disease," says Dr AN Malaviya, consultant rheumatologist, A&R Clinic and visiting senior consultant rheumatologist, Indian Spine Injuries Centre, New Delhi.

WHO’S AT RISK
“Lupus affects young women between 13 and 40 years," says Dr BG Dharmanand, HOD, rheumatology at Manipal Hospital, Bengaluru. "Environmental factors, family history, exposure to oestrogen and smoking, and viral infections are other common risk factors.”

THE SYMPTOMS
These include arthritis, kidney problems, low platelet and WBC counts, psychosis (manic episodes), rashes on face, especially after-sun exposure, mouth sores, and swelling of the lung and heart lining.

RULE IT OUT
This is difficult to diagnose. Doctors will order blood tests to measure your blood cell count, ESR, kidney and liver functions, and the presence of anti-nuclear antibodies (indicative of an autoimmune disease) as well as urine tests to detect increased protein or red blood cells. A false-positive syphilis test may also be indicative of lupus.

HOW TO GET WELL
“About 10 to 15 years ago, the 5-year mortality rates were 80% . But with improved treatment options, 90% of patients survive for 20 years," says Dharmanand. Treatment includes immunosuppresants and immunomodulating agents like steroids. "There are many side effects of steroid use, so it is a matter of balancing the side effects of the drug and the disease symptoms,” adds Dharmanand.


RHEUMATOID ARTHRITIS
Although joint pain and inflammation are the most visible symptoms, this disorder affects every organ in the body; treating it early and aggressively is the best way to tackle the disease.

THE DISORDER
"The name is a misnomer," says Malaviya. Although classified as an autoimmune musculo-skeletal disorder with most visible symptoms like joint pain/inflammation, rheumatoid arthritis (RA) affects every organ in the body. 'We have outstanding medication to treat RA nowadays," says Malaviya, who pioneered the field of
rheumatology in India in 1968 and is credited with discovering the novel applicability of low-dose methotrexate (LDMTX). It is the 'central anchor drug' for the treatment of RA.

WHO’S AT RISK
Although the cause is unknown, RA is more common in women. Among the confirmed risk factors are gum disease (periodonitis) and smoking.

THE SYMPTOMS
Early diagnosis is very crucial, “says Dharmanand. "Symptoms to watch out for include: joint pain and swelling, long-lasting early morning stiffness, fever, weight loss and fatigue.”

RULE IT OUT
Diagnosis is arrived at after clinical examination of the patients and blood tests to detect
presence of rheumatoid factor and anti-cyclic citrullinated peptide (anti- CCP) antibodies. A negative result for rheumatoid factor is not indicative of lack of the disease as this factor is detectable in only 75 to 80% patients.

HOW TO GET WELL
There has been a “quiet revolution" in treating RA, states Malaviya. Besides LDMTX, other drugs prescribed may include non- steroidal anti-inflammatory drugs (NSAIDS), steroids, disease modifying anti-rheumatic drugs (DMARDS), and immunosuppresants.

EXPART SPEAK
“An exciting new discovery is that smoking is a trigger for autoimmune genes to become active” - Dr AN Malaviya



MULTIPLE SCLEROSIS
This condition is characterised by relapses (when new symptoms appear) and remissions (when symptoms improve on their own).

THE DISORDER
Multiple sclerosis (MS) is a disease in which your body's immune system destroys the protective covering on your nerves. This interferes with the communication between your brain and the rest of your body. This ultimately causes irreversible damage to the nerves themselves, which interferes with the functions that are controlled by the nervous system vision, speech, walking etc.

WHO’S AT RISK
“Women are 1.5 to 2 times more likely to get the disease," says Dr BS Singhal, professor and head, Department of Neurology, Bombay Hospital, Institute of Medical Sciences, "and it manifests itself in younger people between 20 and 30 years of age.” Adds
Dr Apoorva Pauranik, professor of neurology, MGM Medical College, Indore, "Asian people are less at risk; it typically affects North Europeans." Genetics, infections, and the presence of other autoimmune conditions are also risk factors.

THE SYMPTOMS
These include loss of vision in one eye, weakness/paralysis of legs, arms, head and neck muscles weakness, tremors, fatigue, and difficulty in swallowing or speaking.

RULE IT OUT
The availability of the MRI has revolutionised diagnosis and treatment. "You can spot lesions in the brain very early in the disease," says Singhal. Other tests include electrical tests that document the velocity of impulses from various parts of the body to the brain and a spinal tap.

HOW TO GET WELL
In many cases, minor symptoms resolve themselves without any treatment. Treatments to control symptoms include immuno-modulating drugs like interferon and glatiramer which slow down the appearance of symptoms and steroids and mitoxantrone to suppress the immune system. However, interferons are very expensive (Rs 25,000 to 30,000 a month) and therefore not accessible to many. Currently, many drugs are in trial and the outlook is optimistic.

TYPE 1 DIABETES
Although most common in children, this form of diabetes (also known as juvenile onset diabetes) is not easily recognised.

THE DISORDER
Type 1 diabetes is a condition where your pancreas produces very little or no insulin, the hormone needed to process sugar to produce energy.


WHO’S AT RISK
Risk factors include family history, genetics, geographical location, exposure to certain viruses, as well as dietary factors like low Vitamin D levels. This disorder is commonly seen in young children (peak age of onset is 12 or 13 years) and in women.
THE SYMPTOMS
“Onset is more dramatic, and if not diagnosed, this condition can potentially be fatal,” says Dr Sanjay Reddy, medical director and consultant, Bangalore Diabetes Centre. "In a lot of cases, the diagnosis is made when the child presents acute complications." Stay vigilant for symptoms like weight loss, excessive urination, hunger, blurred vision, fatigue, etc.
RULE IT OUT
Diagnosis is primarily done based on patient history and age. Abnormal blood sugar levels show up in a random blood sugar test and a glycated haemoglobin (A1C) test. Specific blood tests to confirm diagnosis include checking for the presence of GAD antibody, islet cell antibody, and insulin auto-antibodies.

HOW TO GET WELL
Life-long treatment with insulin is the only option available currently. Patients are also advised to eat right, exercise, and diligently monitor their blood glucose levels.

THYROIDITIS
This autoimmune disorder is characterised by chronic inflammation of the thyroid gland leading to either hypothyroidism or hyperthyroidism.

THE DISORDER
Thyroiditis is a condition wherein the immune cells attack the thyroid gland causing inflammation. This chronic inflammation leads to thyroid cell damage. Depending on the rapidity of the damage, a patient can develop hypothyroidism or hyperthyroidism.

WHO’S AT RISK
Various factors including heredity, gender (women are more susceptible), age (middleaged women), and viral infections playa role. "There is a 50% concurrence in
identical twins indicating that the trigger is 50% genetic and 50% environmental," states Dharmanand.

THE SYMPTOMS
Generalised symptoms may include fever, weight loss, puffiness and joint pain. Typical hypothyroidism symptoms include constipation, weight gain, lethargy and dry skin. Typical hyperthyroidism symptoms include cardiac problems, weight loss, diarrhoea and tremors.

RULE IT OUT
Thyroid function tests and blood tests are normally done.



HOW TO GET WELL
Hypothyroidism is treated with synthetic thyroid hormones. Treatment for hyperthyroidism includes drugs to reduce the effect of excessive thyroid hormones. For example, beta blockers may be prescribed to reduce the impact on the heart. Surgery or radiotherapy to destroy the thyroid gland is also an option.

What are allergies?
Allergies are another form of immune system error which occur when your immune system reacts to a foreign substance (allergen) such as pollen, dust, food, or any other allergen that it would otherwise typically ignore. The resulting symptoms can range from minor irritation to a potentially life-threateninq emergency.

Common allergens
• Dust, pollen, mould
• Penicllin-based antibiotics
• Insect bites (bees, wasps)
• Eggs, nuts, dairy products, wheat

RULE IT OUT
• Skin test
• Blood tests

HOW TO GET WELL
Avoid the allergen
Take steroids, antihistamines, decongestants to relieve symptoms
Purified allergen shots
Epinephrine shots in emergencies