When discussing autoimmune diseases in the previous blog (#19), we identified the phenomenon of epitope spreading contributing to the nature of autoimmune diseases as being specific to a bodily organ or tissue, or conversely being distributed, diffusely among multiple organ systems or tissues throughout the body. This “rogue B-cell” effect combined with the pervasive focal and diffuse vascular effects of chronic inflammation are the highly likely causes of the multisystem organ/tissue-specific clinical manifestations (also diagnosed as multisystem inflammation syndrome in children or MIS-C) synonymous with autoimmune diseases. It should also be noted that multiple autoimmune diseases, organ-specific and/or diffuse, can occur simultaneously in the same patient making the diagnosis of autoimmune diseases infinitely more difficult. So, the diagnosis of autoimmune disease can be challenging for two reasons. First, many of the associated diseases share similar symptoms. Second, as described previously, the disease process may be organ-specific or disseminated among multiple body systems. The diagnostic evaluation includes a thorough history, physical examination, laboratory testing, and imaging based on suspected tissue or organ-system involvement(s).
Regarding the array of autoimmune diseases, there have been more than 80 identified affecting more than 50 million Americans (according to the American Autoimmune Disease Related Association,
AARDA, 2019), 78% of whom are women. Relative to the specific conditions, symptoms range from no symptoms at all to general malaise to severe illness and risk of death. Let’s list the top 10 autoimmune diseases, but because of the limitations of these blog presentations, we’ll have to limit the discussion of their clinical signs and symptoms (Table 5.3); diagnostic criteria; and treatments, including immunotherapeutic agents (Table 5.4), all of which are comprehensively outlined and discussed in “The Paradox of the Immune System” book, of which this entire blog is an abridged version. However, we will be providing an expanded discussion in the next blog (#21) on immunotherapies including those identified in the 10 most common conditions listed below (plus Table 5.2 of 40 additional prevalent autoimmune diseases from among the 80+ identified by NIH).
1. Rheumatoid arthritis (RA)
2. Systemic lupus erythematosus (SLE)
3. Inflammatory bowel disease (IBD)
4. Crohn’s Disease
5. Multiple sclerosis (MS)
6. Type 1 diabetes mellitus
7. Guillain-Barre syndrome
8. Psoriasis
9. Graves’ disease
10. Myasthenia gravis
As we have discussed multiple times throughout these blogs, the nature of CI and autoimmune diseases may be localized, as in specific to a bodily organ or tissue, and/or distributed diffusely among multiple organ systems or tissues throughout the body. As such, CI and autoimmune diseases often require “localized” treatment directed at the tissue(s) and organ system(s) or more “generalized” treatment falling under the categories of immunosuppressive and immunomodulating (suppressing or stimulating) therapies, sometimes referred to as “nonspecific therapies.” Because of the parallel nature of CI and autoimmune diseases, as we have identified and elaborated on their etiologies and pathogenesis in the previous 7
blogs, we’ll devote the next 2 blogs (#21 “Immunotherapies” and #22 “Therapeutic [cellular and genetic] procedures”) to the generic classifications and some specific considerations regarding treatment options (many of which will also be revisited in Blog #23 and #24 on cancer and #25 on infectious disease). This last sentence on treatment considerations in subsequent blogs speaks to the nature of immunotherapies as “nonspecific therapies” as previously mentioned.
Discussion Questions:
Autoimmune diseases can be localized (organ and/or tissue-specific) or diffuse (multiorgan and/or systemic). Can you identify the most prevalent localized and diffuse entities?
Which of the autoimmune diseases would the rogue B-cell, epitope spreading effect likely be associated with and why?
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