Many consequences to immune diseases | News, Sports, Jobs

Conway McLean, DPM

By Conway McLean, DABFAS, FAPWHc

When there is news concerning medical issues these days, it’s commonly regarding infectious disease. If it isn’t about a new strain of COVID, then it’s Bird flu. Or some bacterial infection to which our antibiotics are no longer effective. These discussions all involve in some way the issue of immunity, our ability to fight off infection. The effectiveness of a person’s immune system is an essential part of health and well-being. But what happens when this system goes haywire, when it attacks ‘self’ as opposed to invading microbes?

The immune system is complex and, when working efficiently, it’s capable of eradicating many of the disease-causing microorganisms we are exposed to. Like all complex biologic ‘machinery,’ problems can develop. When the immune system mistakenly attacks healthy cells or tissues, an autoimmune disease is the result. But there are many: scientists have identified over a hundred. Some are part of the lexicon, a common topic of discussion, things like type 1 diabetes, multiple sclerosis, rheumatoid arthritis, while others are quite rare and difficult to diagnose.

With these diseases, the cells composing our defense system can’t tell the difference between foreign cells and those of the body, be it blood vessels, joint structures, or skin. There are numerous different targets for a malfunctioning immune system. And some of these involve multiple tissue types and varied organs. In addition, they vary tremendously in severity, some people having mild manifestations and others disabling ones.

The cells of the pancreas responsible for producing insulin are attacked in type 1 diabetes. Rheumatoid arthritis is one of many conditions involving joint structures in some way. Lupus (systemic lupus erythematosus or SLE) does as well, but also targets skin and other organs. Many individuals with skin involvement of psoriasis also have joint involvement, termed psoriatic arthritis. But with so many different autoimmune diseases, almost every organ will be subjected to the body’s assault.

Probably the most important member of our defense system is the white blood cell. These have many functions, among them the production of antibodies, specialized proteins capable of identifying a foreign invader and then educating the immune system to produce more antibodies specific for that invader. Should that bacterium be encountered again, the appropriate defenses are already programmed in.

People with these less common manifestations often suffer for years before a diagnosis is made. These are not ‘black and white’ diseases, the root of the illness ascertained with a simple blood test. A constellation of factors are required, from a collection of symptoms, various blood markers, sometimes even a tissue biopsy is needed. And the symptoms can be the result of numerous other conditions, again obscuring a cause.

A specific indicator of autoimmune system dysfunction looks at antinuclear antibodies (aka ANA). A positive test indicates the presence of these specialized proteins, meaning the immune system has produced antibodies against parts of your own cells. Likely the greatest controversy regarding autoimmune disease is the steady increase over time in the presence of ANA in the population. The findings from numerous studies indicate autoimmune diseases are becoming more prevalent since we are seeing more of these antinuclear antibodies in the population.

Symptoms naturally vary greatly with so many of these conditions, since so many different tissues and organs can be affected. Obviously, the organ targeted will determine the changes. Some of those more frequently experienced include fatigue, painful joints, rashes. Many of these problems, including lupus, rheumatoid and psoriatic arthritis, and others, lead to heart problems. The symptoms of type 1 diabetes are well-documented and strictly the consequence of impaired insulin production and the subsequent increase in blood sugar levels.

Approximately 8% of the US population is affected by an autoimmune disease. But a discussion of who is prone to developing one of these diseases is difficult since we really don’t understand why they occur. They are more common in women, typically arising between the ages of 15 and 45. A family history positive for an autoimmune condition means one is more likely to suffer from one. Environmental factors also have been implicated, with exposure to such varied items as sunlight, cigarette smoke, various solvents, and certain viral infections.

Ethnicity also seems to be an issue, with Caucasians from Europe frequently experiencing an autoimmune muscle malady, while those of African American and Hispanic lineage more often develop lupus. Being overweight raises one’s risk of developing RA or psoriatic arthritis. As to why only brings up more questions. Is it because the weight places more stress on the joint structures or because adipose tissue (fat) releases the products of inflammation?

As to the treatment of autoimmune disorders, most of these diseases are incurable, with only symptomatic relief possible. The ubiquitous anti-inflammatory medications are frequently prescribed, including such popular items as ibuprofen and Naprosyn. Steroids are another common choice for reducing symptoms via the reduction of systemic inflammation, a task corticosteroids are well-suited to. Pain relievers, both prescription meds and over the counter drugs, are utilized for the discomfort. Immunosuppressant drugs can have complex effects on the body and need to be carefully monitored but can have great benefits.

We know so little about the autoimmune diseases. We don’t know what triggers recurrence of symptoms, or why some people develop these conditions and others don’t. The increasing prevalence of these conditions, as reflected in the frequency with which ANA antibodies are now appearing in the global population, is a cause of considerable concern. For those individuals suffering from one of the myriad autoimmune diseases, we can only offer relief of symptoms and no impending development of a cure. Let’s be honest; modern medicine has its shortcomings.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.