Scleroderma

In instances where there is an uncontrolled or unregulated immune response to the normal antigens of the host body however, this phenomenon can be described as Autoimmunity. Dr. Rose contrasted this autoimmune diseases which are essentially disorders resulting from the autoimmunity.

Statistics presented, revealed that autoimmune diseases are twice more prevalent than cancer, which affects approximately 9 million persons in the United States. Autoimmune diseases on the other hand, affect some 14.7 to 23.5 million persons, thereby constituting a major public health threat. It was on par with heart disease with 22 million affected and accounted for the 10th leading cause of death amongst women under the age of 65. Dr. Rose pointed out that over $100bn is being spent annually in health care costs resulting from autoimmune diseases.

Despite the over 100 known autoimmune diseases, the three most common are Graves’ Disease, Rheumatoid Arthritis, and Hashimoto Thyroiditis. Others are considered to be rare and include Vitiligo, Systemic lupus Erythematosus (SLE), Sjogren’s syndrome, and Scleroderma.

Examples of autoimmune diseases grouped by categories were shared as follows;

• Blood – Hemolytic anemia, and Thrombocytopenia
  
• Connective Tissue – Lupus, Rheumatoid Arthritis, Scleroderma
• Endocrine – Type 1 Diabetes, Graves’ Disease, Hashimoto Thyroiditis
  
• Neurological – Myasthenia Gravis, Multiple Sclerosis
• Gastrointestinal – Inflammatory Bowel Disease, Chronic Active Hepatitis
• Skin – Pemphigus, Psoriasis, Vitiligo
• Kidneys – Glomerulonephritis
  
• Heart – Rheumatic Fever, Myocarditis
  

Dr. Rose went on to add that autoimmune diseases are highly varied and diverse in their presentation or manifestation and effects, ultimately requiring the input of different medical practitioners or specialists, treating affected individuals under differing rules. Some specialists include rheumatologists, dermatologists, cardiologists, and gastroenterologists.

A strong female bias with autoimmune diseases has also been recognized, which adds an additional layer of complexity in its understanding and treatment. Research has shown that oestrogen tends to increase autoimmune responses and prolactin levels are raised with some autoimmune diseases. Similarly, the behaviour of autoimmune diseases does tend to fluctuate during and after pregnancy.

In discussing the causes for autoimmune diseases, Dr. Rose outlined two major categories of factors that exist: genetic and environmental. Genetic predispositions involved family clusters, 30% twin concordances, and HLA. HLA was tied to those major groups of genes that distinguish one person from another. Environmental triggers do play a critical role in the prevalence of autoimmune diseases and include drugs, viruses, foods, pollutants, hormones, and stress.

In closing, Dr. Rose extended a call for all of us to get on the train of autoimmunity. The major research goal for us today, he said, is to understand that all diseases, diverse as they are in their anatomical locations and in their clinical manifestations, are related because they have the same aetiology; they are all caused by the train of autoimmunity. In an effort to develop effective treatments, we need to treat the cause of the disease, not the symptoms. The symptoms often arise late, at the end of train of events. We need then, to get on at the beginning.