Effective immune-mediated therapies for autoimmune diseases

Autoimmune treatments

MEDICAL BLOG by Dr Fatima Tariq

Have you heard about autoimmune diseases earlier? Well, it’s a condition in which your body fails to differentiate between self and non-self, attacks its tissues, and damages organs. Studies reported that 6.4% of women and 2.7% of men have the chance of getting autoimmune diseases, which means that women have a higher rate of getting these diseases than men, especially during their childbearing ages [1].

Is there any effective treatment available for treating autoimmune disorders? Fortunately, scientists have found immune-mediated therapies, including immune-suppressing drugs, effective in alleviating its symptoms.

Please read this article to learn more about autoimmune diseases, their types, and treatments!

Immune-Mediated Therapies

What are autoimmune diseases?

Autoimmune disease is when your body’s immune system attacks itself instead of protecting it. The immune system comprises different organs and cells responsible for protecting your body against pathogens and cancerous cells. When any foreign pathogen invades, the host immune system detects it, which activates immune cells to attack the pathogens. Usually, the immune system attacks specifically any seen foreign bacteria and viruses. While in this disease, the immune cells attack the normal cells by releasing different proteins called auto-antibodies that attack these normal cells.

More than 80 autoimmune diseases are known up until now; some include lupus, rheumatoid arthritis, and ulcerative colitis. In some cases, these diseases target only one organ, like type 1 diabetes, which damages the pancreatic cells. While other conditions, like systemic lupus erythematosus (SLE), can affect many organs, ultimately affecting the whole body. Some of them, like multiple sclerosis and lupus, can be inherited. Along with this, a diet including more fat, sugar, and processed foods, can also be one of the factors for getting an autoimmune disease [2].

How common are autoimmune disorders?

In the US, almost one in fifteen people have this autoimmune disease. In addition, in the US, approximately one million people have systemic lupus, while 1.4 million have ulcerative colitis or Crohn’s disease [3].

What are the common autoimmune diseases?

The incidence of autoimmune diseases is increasing from 3% to 9% a year worldwide. More than 80 autoimmune diseases have been known worldwide, including rheumatoid arthritis, multiple sclerosis, and type I diabetes mellitus [4]. However, some of the common autoimmune diseases are discussed below:

Inflammatory bowel disease (IBD)

IBD is an autoimmune disorder in which inflammation occurs in the lining of the intestinal wall. It has different types, which can affect various parts of the gastrointestinal (GI) tract; Crohn’s disease cause GI tract inflammation of any amount from the mouth to the anus. In contrast, ulcerative colitis can affect only the colon (large intestine) and rectum lining. In the American population, almost half a million have Crohn’s disease, usually appearing early, between 20 and 30s [5]. IBD’s common symptoms include diarrhea and abdominal pain.

Systemic lupus erythematosus

It is another common autoimmune disorder affecting connective tissue and many organs, including the joints, kidneys, brain, and heart. Lupus commonly occurs in females of 15 to 45 years of age [6]. It mainly occurs in their reproductive ages due to increased levels of estrogen. The most common symptoms include joint pain, inflammation, fatigue, fever, facial rashes, and weight loss.

Rheumatoid arthritis (RA.)

Rheumatoid arthritis is one of the most familiar auto-immune diseases affecting 1.3 million people in the US [7]. Most commonly, it affects people at an older age. Still, it can start in their early 30s or even sooner. The typical presentation of the disease involves joint swelling, pain, and stiffness affecting only the small joints, such as joints of hands, feet, and wrists.

Here I am mentioning a few points which can help you differentiate whether your joint swelling is due to RA or for some other reason. 

  1. Joint swellings related to RA are always symmetrical, i.e., affecting both sides of the body. If you are experiencing stiffness only in the joints of one hand, it is unlikely to be due to RA.
  2. In RA, joint stiffness worsens when you wake up in the morning, typically known as morning stiffness. This stiffness lasts more than 30 minutes and subsides as you start moving your joints. Stiffness lasting less than 30 minutes is unlikely to be due to RA.

In the late stages, joints become deformed, hindering your daily work. Therefore, you should consult your doctor if you experience any symptoms so that treatment can start at the initial stages.

Psoriatic arthritis

Psoriasis affects the skin causing itchiness and discomfort. It causes cells of your skin to multiply rapidly. It causes more cells to build up, ultimately forming swollen, red patches with scales on the skin. Approximately 30% of psoriasis patients have swelling in their joints, stiffness, and joint pain leading to psoriatic arthritis. One in every three people diagnosed with psoriasis develops arthritis due to joint inflammation [8].

Graves disease

Graves disease can affect the thyroid gland in the neck responsible for producing thyroid hormones. These hormones are essential in controlling metabolism, so their higher level can affect body activities and cause many symptoms like weight loss, increased heart rate, heat intolerance, anxiety, and diarrhea. It can also cause bulging of the eyes. It is mainly seen in people in their 30s to 50s, but it also happens in children and older people [9].

Multiple sclerosis

In multiple sclerosis (MS), the myelin sheath gets damaged, affecting the nerves in the central nervous system (CNS) and the signal transmission speed between the brain, spinal cord, and the body. It can cause weakness, numbness, balance issues, and walking problems.

In the US, 1 million adults suffer from MS. It is usually diagnosed between 20-40 years [10]. It has various symptoms based on which part of the CNS is affected, including paralysis, numbness, and vision impairment. In almost 50% of MS cases, within 15 years after the onset of the disease, patients need help walking.

Gillian Barre syndrome (GBS)

In GBS, the immune system attacks the nerves causing the body to lose its ability to control muscles leading to numbness, tingling, and muscle weakness. This rare syndrome mainly occurs in older people. In the US, 3000 to 6000 people develop GBS each year [11]. Some of the common symptoms include hands and feet numbness or tingling, back pain, muscle weakness, difficulty in breathing and swallowing, hypertension, and increased heart rate.

Is cancer an immune-mediated disease?

Cancer is a malignant disease with multiple causative factors that all cause this deadly disease. Out of all other factors, the immune system also plays a significant role in causing cancer in some cases. By creating an inflammatory microenvironment, immune cells contribute to tumor formation. In normal cells, mutations, genomic instability, and epigenetic modifications occur that play a crucial role in developing tumor cells [12].

Is diabetes an immune-mediated disorder?

Type 1 diabetes is an autoimmune disease. In this disease, your immune system targets the beta cells of the pancreas responsible for producing insulin. Without insulin, your body cannot effectively control glucose, increasing blood glucose levels. As your pancreas cannot produce insulin, you must take insulin in medication form.

The disease can be detected through early screening of antibodies against the pancreas in blood. Unfortunately, most of the patients are diagnosed at later stages. Once diagnosed at the very initial stages, several immune-mediated therapies can change the outcome of the disease process. At that stage, the only treatment that works is insulin therapy.

Type 2 diabetes mellitus is claimed to be a lifestyle related disease. However, it also involves some components of auto-immunity. The severity of type 2 diabetes is much lower than that of type 1. Based on this fact, type 2 diabetes can be treated effectively with immune-mediated therapies at the initial stages.

How to know if someone has an autoimmune disease?

It is hard to diagnose an autoimmune disorder, mainly if it’s in the early stages and if many organs are involved. No single diagnostic test can be used to detect this disorder. Based on the type of autoimmune disease, diagnosis methods vary.

First, the doctor will undergo a physical examination, review your symptoms, check your medical history, and then conduct some blood tests to detect autoantibodies to detect the autoimmune disorder.

Along with these, X-rays and biopsies can also be used for its diagnosis. Doctors can also use an antinuclear antibody (ANA) test to detect this disease, but several other blood tests are also required.

What are the various treatment options?

No specific treatment is available for curing autoimmune diseases, but several medications are prescribed to control the overactive immune system and reduce their symptoms of pain and inflammation. Several drugs are used to reduce pain and inflammatory symptoms, including NSAIDs and immune-suppressing drugs. Along with these medications, a well-balanced diet and regular exercise can make a person feel better.

Are Immune-mediated therapies more effective than conventional therapies?

The immune-mediated therapies are more effective than conventional therapies as conventional treatments for autoimmune disease can modulate immune responses that can control and reduce inflammation. Previously, many biological drugs and inhibitors targeted inflammatory cytokines, immune cells, and kinases that can help treat autoimmune diseases.

For example, in a study, researchers found that several immune suppressive drugs that negate the function of inflammatory markers, such as TNF, IL-6, IL-17, and IL-23, are very effective in treating various autoimmune disorders, like rheumatoid arthritis, spondylitis, and psoriasis [13].

One of the gut hormones, glucagon-like peptide 1 (GLP-1), can be used to treat diabetes mellitus, an autoimmune disorder. It has an anti-inflammatory response that can reduce inflammatory cell levels and inflammatory markers, including TNF-α and IL-1/6. In addition, it can also enhance anti-inflammatory adipokine adiponectin levels that help in the favorable growth of the pancreas [14].

One study showed that interleukin 21 (IL-21) is a crucial marker of inflammation formed by activated T-cells that help modulate the immune response. Targeted therapies against this marker can serve as a novel method in treating conditions like IBD, diabetes, RA, and lupus [15].

Immune-mediated therapies have other benefits too. For example, another study showed that TNF-1 therapy help in reducing cancer incidence among rheumatoid arthritis patients [16].

The Bottom Line

Living with an autoimmune disease can be difficult as many diseases like lupus, RA, and multiple sclerosis are associated with it that are very complex and severe. Although no cure is available for this disorder, many drugs can alleviate their symptoms. It would be best if you stay in touch with your doctor to learn about your disease’s advances and treat it.

So, if you think you have any of this disease, don’t wait; quickly rush to your doctor for its diagnosis and treatment. If the condition is promptly treated, the severity of the disease can be significantly reduced.

References

1. Hayter SM, Cook MC. Updated assessment of autoimmune disease’s prevalence, spectrum, and case definition. Autoimmunity Reviews [Internet]. 2012 Aug 1 [cited 2023 Jan 4];11(10):754–65. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1568997212000225?via%3Dihub

2. https://getliner.com/picked-by-liner/reader-mode?url=https%3A%2F%2Fwww.healthline.com%2Fhealth%2Fautoimmune-disorders

3. Autoimmune Diseases: Causes, Symptoms, What Is It & Treatment [Internet]. Cleveland Clinic. [cited 2023 Jan 4]. Available from: https://my.clevelandclinic.org/health/diseases/21624-autoimmune-diseases#:~:text=An%20autoimmune%20disease%20is%20the

4. Campbell AW. Autoimmunity and the Gut. Autoimmune Diseases [Internet]. 2014 [cited 2023 Jan 4];2014:1–12. Available from: https://www.hindawi.com/journals/ad/2014/152428/

5. Cleveland Clinic. Crohn’s disease | Cleveland Clinic [Internet]. Cleveland Clinic. 2016 [cited 2023 Jan 4]. Available from: https://my.clevelandclinic.org/health/diseases/9357-crohns-disease

6. Cleveland Clinic. Systemic Lupus Erythematosus: Causes, Treatments [Internet]. Cleveland Clinic. 2021 [cited 2023 Jan 4]. Available from: https://my.clevelandclinic.org/health/diseases/4875-lupus

7. Cleveland Clinic. Rheumatoid Arthritis | Cleveland Clinic [Internet]. Cleveland Clinic. 2017 [cited 2023 Jan 4]. Available from: https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis

8. Psoriasis | Cleveland Clinic [Internet]. Cleveland Clinic. 2016 [cited 2023 Jan 4]. Available from: https://my.clevelandclinic.org/health/diseases/6866-psoriasis

9. Cleveland Clinic. Graves’ Disease: Symptoms, Causes, Treatments & Tests [Internet]. Cleveland Clinic. 2020 [cited 2023 Jan 4]. Available from: https://my.clevelandclinic.org/health/diseases/15244-graves-disease

10. Cleveland Clinic. Multiple Sclerosis [Internet]. Cleveland Clinic. 2021 [cited 2023 Jan 4]. Available from: https://my.clevelandclinic.org/health/diseases/17248-multiple-sclerosis

11. Guillain-Barré Syndrome (GBS): Causes, Symptoms & Treatment [Internet]. Cleveland Clinic. [cited 2023 Jan 4]. Available from: https://my.clevelandclinic.org/health/diseases/15838-guillain-barre-syndrome

12. Shurin M. Cancer as an immune-mediated disease. ImmunoTargets and Therapy. 2012 Jun;1.

13. Jung SM, Kim W-U. Targeted Immunotherapy for Autoimmune Diseases. Immune Network. 2022;22(1).

14. Hogan AE, Gaoatswe G, Lynch L, Corrigan MA, Woods C, O’Connell J, et al. Glucagon-like peptide one analog therapy directly modulates innate immune-mediated inflammation in individuals with type 2 diabetes mellitus. Diabetologia. 2013 Dec 21;57(4):781–4.

15. Monteleone G, Pallone F, Macdonald TT. Interleukin-21 as a new therapeutic target for immune-mediated diseases. Trends in Pharmacological Sciences. 2009 Aug;30(8):441–7.

16. Haynes K, Beukelman T, Curtis JR, Newcomb C, Herrinton LJ, Graham DJ, et al. Tumor necrosis factor α inhibitor therapy and cancer risk in chronic immune-mediated diseases. Arthritis & Rheumatism [Internet]. 2012 Dec 27 [cited 2023 Jan 4];65(1):48–58. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778442/

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Picture of Dr. Fatima Tariq

Dr. Fatima Tariq

Hi there. This is Dr. Fatima Tariq. I did my MBBS from one of the prestigious medical schools in my country. My years in medical college have helped me to polish my writing skills to perfection. I have been working as a freelancer for 4 years now. My writing is very concise, easy-to-read, and well-researched. My biggest priority is conveying the information in an informative and professional way.

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