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For other articles and previous issues click here. September 20, 2004 Systematic
Attack According to one organization, autoimmune diseases, which destroy the body’s cells and tissues, need to be considered as a new disease category to further research efforts. Often, it can seem like modern medicine is the arena for exciting new discoveries but no real cures. This would appear to be the case concerning autoimmune diseases such as multiple sclerosis (MS), fibromyalgia, juvenile diabetes, Graves’ disease, lupus, antiphospholipid syndrome, chronic fatigue syndrome, rheumatic fever, and rheumatoid arthritis. In all, there are more than 100 varieties of autoimmune diseases, according to Virginia Ladd, founder/president, the American Autoimmune Related Diseases Association (AARDA), East Point-East Detroit, Mich. AARDA, founded by Ladd 15 years ago, is one of those rare healthcare organizations that the founder wouldn’t mind seeing go out of business. Ladd says there are “common biomarkers,” or threads, to these many diseases, and she suggests they should be studied as a group. Although she says there has been movement in the medical community over the past five years, “by far the most research is a single-disease focus.” Ladd’s thoughts are echoed in Women and Autoimmune Disease by Robert G. Lahita, MD, PhD, which looks in some detail at 16 of these diseases. Lahita, a professor of medicine at the Mount Sinai Medical School and chairman of medicine and vice president of the Jersey City Medical Center, is generally regarded as one of the leading authorities on autoimmune disease. In his book, he provides generalizations on a wide range of medical and drug therapies and alternative and complementary therapies—from acupuncture to zinc—which he’s not necessarily opposed to. He talks about the importance of diet and nutritional regimes, exercise and rest, mind-body therapies, massages, spas, and religion and spiritual beliefs—they all can help—as well as “living well.” Lahita says, “Studies tell us that frequent laughter has been shown to improve immune function, raise resistance to infection, and increase life span.” However, perhaps his most important point is: “To date, there is no cure for autoimmune diseases.” He then follows with, “Now, the good news: So far. We are working on it. Rest assured that for every autoimmune disease, there is a laboratory—perhaps hundreds of laboratories—with a group of scientists hunched over computers, calibrating test tubes, looking through microscopes at cells, and analyzing genes and molecules in an attempt to define their roles.” However, for Ladd, studying these diseases in isolation is not enough. “There is a significant need for more collaboration and cross-fertilization of basic autoimmune research,” she says. “Research that focuses on the etiology of all autoimmune-related diseases rather than a singular one will bring us to the root causes rather than the superficial level of treating the symptoms after the disease has had its destructive effects.” The AARDA position is that autoimmunity should be treated comprehensively as a new disease category, similar to the way cancer is lumped into one category. The argument here is that unlike cancer, which is an umbrella category for a range of diseases (eg, leukemia, breast cancer, prostrate cancer, non-Hodgkin’s lymphoma), autoimmunity has yet to be embraced by the medical community (and the public) as a category of disease. Because these diseases cross the different medical specialties, such as rheumatology, endocrinology, hematology, neurology, cardiology, gastroenterology, and dermatology, and because such specialties usually focus on singular diseases within their particular category, there has been virtually no general focus on autoimmunity as the underlying cause. As one indication of the possible commonality of these diseases, Ladd points out that MS is different from juvenile or type 1 diabetes, but both are marked by inflammation. In MS, the inflammation is more obvious because of joint pains. However, in diabetes, an underlying inflammation leads to an attack on the insulin-producing cells. A symptom of both MS and type 1 diabetes is extreme fatigue. The common thread between all autoimmune diseases is that the person’s immune system attacks his or her own tissue—or, as Ladd calls it, “friendly fire.” Autoimmunity is distinguished from AIDS in that the latter is an acquired virus that attacks the immune system. Nor is autoimmunity a cancer, which is characterized by unhealthy, parasitical cells attacking and taking over healthy ones. One of the functions of the immune system is to respond to invading microorganisms, such as viruses or bacteria, by producing antibodies or sensitized lymphocytes (types of white cells) that will recognize and destroy the invaders. However, in autoimmune diseases, something goes out of whack and these reactions take place against the body’s own cells and tissues, producing approximately 100 variations of the same immune system malfunctioning. There have been several deleterious consequences from this general failure to recognize that autoimmunity is basically a single disease state with many variations as opposed to 100 different conditions. One is that many of the conditions, by themselves, do not appear to affect many people. However, taken all together, it turns out that one in five Americans, or as many as 22 million people, have an autoimmune deficiency. Of these cases, 75% affect women. Autoimmune diseases are among the top 10 leading causes of death among women and children in the United States. In Canada, where the healthcare dollars are tracked, one out of every seven dollars goes to these diseases, not including the amount spent by the pharmaceutical industry. This splintering effect has also affected research funding. “Myasthenia gravis, a very significant neurological autoimmune disease, does not have a high enough incidence and morbidity rate in itself to attract attention, so it receives only $1 million of the National Institutes of Health [NIH] $27 billion budget,” Ladd says. “Even type 1 diabetes merits less than 2% of the NIH budget.” However, some changes seem to be on the horizon. The office of Research on Women’s Health, a unit of the NIH, has targeted autoimmunity as one entity. Congress, in fact, has approved a research-mandated plan advocated by the NIH, the FDA, and other organizations for a comprehensive treatment of this disease state. However, the mandate is unfunded. Not to get lost in the shuffle is the effect these diseases have on their victims. Even though there is some universally accepted knowledge about autoimmunity, its victims—mostly women—have suffered from lack of focus and a scattered research approach. For example, autoimmunity is known to have a genetic component and tends to cluster in families as different autoimmune diseases. In some families, a mother may have lupus; her son, juvenile diabetes; his sister, antiphospholipid syndrome; and her grandfather, rheumatoid arthritis. Getting a proper diagnosis is sometimes as difficult as living with the disease itself. Victims face problems not only because physicians often don’t consider autoimmunity but also because of who the majority of them are: women in their childbearing years. As a rule, this is a time in a woman’s life when she looks healthy, but looks can be deceiving. Often, women who suffer from autoimmune diseases are not taken seriously when they first begin consulting their doctors. A woman’s symptoms are likely to be vague at first. Headaches, nausea, or exhaustion that come and go are difficult to describe accurately. In a typical scenario, the patient is often shuffled from specialist to specialist and forced to undergo a battery of tests and procedures before a correct diagnosis is made, which can sometimes take years. According to a 2001 survey by AARDA, more than 45% of patients with autoimmune diseases have been labeled chronic complainers in the earliest stages of their illness. “This can be devastating to a young woman who may then begin to question her sanity as she desperately tries to find out what is wrong,” Ladd says. “Tragically, many of these patients suffer significant damage to their organs in the meantime and end up carrying this health burden with them for the rest of their lives because of the delay in diagnosis.” If the public, in particular women and medical practitioners, were more aware of the genetic predisposition to these diseases, clearly there would be more emphasis on gathering a medical history when a patient presents with confusing symptoms. “Earlier screening of these diseases could not only prevent significant and lifelong health problems but also actually prevent some autoimmunity,” Ladd maintains. An example she offers is antiphospholipid antibody syndrome (APS). This disease causes the victim to produce antibodies against phospholipids—body fats found in every cell wall. APS can result in blood clotting, which can cause stroke, miscarriages, migraine headaches, and clotting disorders. APS, which occurs by itself or may accompany many of the related diseases, is a significant cause of both stroke in women under the age of 35 and recurrent miscarriage, yet it would be unusual for a patient with an autoimmune disease other than lupus to be checked for it. APS has also been indicated as a causative factor in cardiovascular disease in women. The fortunate fact is that APS can be treated simply and prophylactically, with either baby aspirin or other blood thinners that are given to prevent strokes, miscarriage, and blood clots. “The sad fact, however, is that many patients who could be treated in such a manner are never identified until after they have had the stroke or miscarriage,” Ladd says. She adds that it’s been estimated that the costs of these diseases are approximately $86 billion per year. Broadly speaking, there are currently two main modes of treatment: replacing what has been destroyed by the attack and diminishing the activity in the immune system. An example of the replacement option is replacing hormones that are not being produced by the gland, such as thyroxin in autoimmune thyroid disease or insulin in type 1 diabetes. In autoimmune blood disorders, it may be necessary to replace components of the blood by transfusion. Diminishing the activity of the immune system requires a delicate balance between controlling the disorder and maintaining the body’s ability to fight diseases. There is intravenous immunoglobulin therapy used in the treatment of some of these diseases to reduce circulating immune complexes. Some mild forms of rheumatic autoimmune diseases are treated by relieving the symptoms with nonsteroidal anti-inflammatory medications. New drugs, called TNF inhibitors, focus on the immune system, blocking a particular hypersensitivity reaction. The drugs most commonly used, however, stem from cortisone, a steroid discovered in 1940 by Philip Hench, MD, who won the Nobel Prize for his efforts. In his book, Lahita calls cortisone “the pillar of the immunosuppressives. Because of cortisone, some patients with rheumatoid arthritis who had been unable to walk can now do so with little or no difficulty. Unfortunately, however, those patients who thought this drug was the Holy Grail did not realize the number of side effects that came with it. Cortisone can have consequences that are almost as devastating as the diseases that it is designed to alleviate ... which is why I usually try to avoid prescribing it whenever I can. I am particularly careful about using it for chronic diseases, such as rheumatoid arthritis, because when cortisone frees a patient of pain, [he or she] is naturally reluctant to come off the drug. But in fact, as time goes on, patients sometimes require more to feel well, and this only promotes worse side effects.” Ladd reports that, except for a few minor and still largely unproven efforts, there has been no new treatment for autoimmune diseases since cortisone. — Thomas G. Dolan is a medical/business writer based in the Pacific Northwest. |
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