Recently I met a new patient who had waited several months for her appointment. At this first meeting, I was quickly able to diagnose Rheumatoid arthritis. Like others with this disease, her joints were swollen, and she was stiff getting up and moving to the exam table. During our discussion I learned she had felt well until about six months before. There was no good explanation for the onset of her symptoms, so she asked the question, many ask... Why did this happen?
As a rheumatologist, I specialize in managing autoimmune diseases such as Rheumatoid arthritis, as well as several others. Autoimmune disorders are a group of diseases where the immune system mistakenly targets and attacks the body’s own tissues. The system of checks and balances that keeps our immune system running is broken, and the attack goes unaddressed by the body. Managing autoimmune diseases means turning down the volume on an overactive immune system to alleviate symptoms and prevent damage to one’s body. Like my patient, many ask, what makes our immune system make these mistakes?
Well, as we currently understand it, a combination of genetic predisposition and environmental triggers plays a role in the development of autoimmune disorders. Certain genes are associated with an increased risk. Environmental factors, such as infection, exposure to certain chemicals, or hormonal imbalances could trigger or exacerbate an immune response. All this to say, there are multiple reasons autoimmune disorders flare up, but it is difficult to determine the exact cause and likely there is more than one factor.
Diagnosing autoimmune disorders can be challenging. The symptoms are wide ranging and overlap with other diseases. We have blood tests that identify specific markers of disease and inflammation. During the physical exam I look for rashes, joint swelling, circulation changes, hair loss, weight loss, and weakness, amongst other things. Interpreting the patient’s story, lab tests, and exam together helps paint a picture that leads to a specific diagnosis.
However, the work isn’t done once there’s a diagnosis. Treatment for autoimmune disorders is unique to each person. Rheumatologists can prescribe medications that target specific immune cells that drive the process. Traditional treatments such as corticosteroids and immunosuppressants are used, but newer specific cell therapies, such as monoclonal antibodies, are also effective. We are also learning about ways to mobilize the immune system and restore its resilience. The future of medicine looks to tailor treatments based on individual genetic profiles and disease characteristics.
Today, I can offer my new patient confidence that she will feel better with current treatments. However, she will have to continue taking medications to remain comfortable. Ideally, we will soon find treatments that allow patients to stop medication and be well. The future holds promise that we will improve diagnosis, targeted treatment, and quality of life for people living with autoimmune disorders.
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc®. For free and easy access to the entire Prairie Doc® ® library, visit www.prairiedoc.organd follow Prairie Doc® on Facebook. Jennifer May, M.D. is a contributing Prairie Doc® columnist. She practices rheumatology in Rapid City, South Dakota at Rapid City Medical Center and serves on the Healing Words Foundation Board of Directors, a 501c3 which provides funding for Prairie Doc® programs.
