Systemic autoimmune diseases are conditions that can affect many organs, cells or tissues simultaneously instead of only one. These conditions can be challenging to diagnose since they may present with nonspecific symptoms that could mimic other conditions. Among one of the leading causes of death and disability among rheumatological patients, improved knowledge, care and treatments have vastly improved the care of those with such diseases. Common systemic autoimmune diseases include:
Systemic Lupus Erythematosus (SLE, Lupus) is probably the most famous of all the systemic autoimmune diseases. It is an autoimmune disease that can range from very mild or episodic symptoms, to a serious chronic illness affecting internal organs. Lupus can cause inflammation in the joints, skin, kidneys, blood cells, brain, heart and lungs. Symptoms often vary from person to person but can include fatigue, joint pain, rash and fever which can periodically get worse, or flare, then improve. There is no cure for lupus, but current treatments focus on improving quality of life for those affected by controlling symptoms and minimizing flare-ups through lifestyle modifications and medication management.
Identified most often by its two most common symptoms, dry eyes and mouth, Sjogren’s causes the body’s immune system to attack the cells which produce saliva and tears. Sjogren’s can occur at any age but older women (over the age of forty) are the most common individuals with this disease, and it can coexist with other autoimmune diseases such as rheumatoid arthritis and lupus. Treatments focus on relieving symptoms and can differ for each person and may include artificial tears for dye eyes and using sugar-free candy or frequently drinking water for a dry mouth. Currently, there is no known proven medication that can stop or reverse the progression of dry eyes and mouth.
Dermatomyositis and Polymyositis are two of the most common types of inflammatory myositis. Inflammation of the muscles and weakness occur in both conditions while patients with dermatomyositis also have a rash. The loss of muscle strength occurs in the large muscles around the neck, shoulders and hips. In rare serious cases some patients can develop dysphagia (weakness of the esophagus) or respiratory failure (weakness of the diaphragm). Treatment is geared toward reducing inflammation of the muscles so that they can gain back their strength and function. Most individuals are encouraged to limit physical activities until signs of inflammation have been reduced or gone away.
Scleroderma is a rare autoimmune disease that causes thickening, tightening, and scarring of the collagen-containing organs in the patient’s body. Collagen is found in the skin, blood vessels, lungs, kidneys, heart, gastrointestinal tract. Scleroderma can vary from person to person ranging from mild to very serious internal organ involvement. CREST syndrome is a limited scleroderma variant characterized by “calcinosis, Raynaud’s, esophageal dysmotility, telangiectasias.” While there is no cure for scleroderma, it is important to recognize and treat organ involvement early to prevent irreversible damage, protect function, and maintain or improve quality of life.
Mixed Connective Tissue Disease (MCTD) is a rare autoimmune disease associated with characteristic high levels of RNP autoantibody and can have features of SLE, scleroderma, polymyositis and sometimes RA. Typically, symptoms of these various conditions do not appear at a single time and instead occur over a number of years and this often makes an accurate diagnosis more complicated. Early signs can include a general feeling of unwellness, cold or numb fingers and/or toes, swollen fingers or hands, muscle weakness or joint pain, and sometimes a rash. Treatment is aimed at the specific manifestation that is affecting the patient’s quality of life and prevention of serious organ damage.
Undifferentiated Connective Tissue Disease (UCTD) is an umbrella term that refers to patients who may have an abnormal blood test called a positive ANA and autoimmune disease-like symptoms such as fatigue, joint pain, nonspecific rash, hair loss, dry eye and mouth, sores in the nose or mouth, but do not meet full criteria for any well-defined autoimmune disease. This could be considered as a mild “pre-autoimmune disease.” You can think of this analogous to prediabetes and full diabetes. Some patients are monitored on no treatment, and others start with treatment, depending on their manifestations and quality of life. Patients with UCTD are closely monitored if there could be any signs or red flags heralding progression into a well-defined autoimmune disease.
Polymyalgia Rheumatica (PMR) causes aching muscle pain and stiffness, most commonly in the shoulders, upper back and hips. This condition classically occurs in Caucasian adults over age fifty, women more than men, and can sometimes develop suddenly, even overnight. It can sometimes co-exist with giant cell arteritis (GCA). PMR is very treatment responsive to moderate and low doses of corticosteroids and can go into remission after a 6-12 months steroid taper.
Systemic autoimmune diseases are treated based on current evidence-based guidelines. Treatment is customized based on what body part is currently affected and symptomatic to the patient, prevention of serious organ involvement, and patient preference. Initial fast-acting treatments are typically oral or injection corticosteroids such as prednisone or NSAIDs. DMARDs and Biologics are used as ‘steroid sparing agents’ and are more specific and targeted treatment for the disease. Depending on the patient’s needs, sometimes DMARDs and Biologics may be combined. Common DMARDs used for systemic autoimmune diseases include hydroxychloroquine, methotrexate, and Cellcept. Infusion biologics offered by Lomibao Rheumatology & Wellness Care for treatment of systemic autoimmune disease are Benlysta and Rituxan. Wellness services for systemic autoimmune diseases – coming soon!