When you’re diagnosed with an autoimmune disease like rheumatoid arthritis or Type 1 diabetes, you’ll likely hear that it’s incurable but manageable, with many conventional and complementary approaches to treatment. But you probably won’t hear that having one condition increases your risk for getting another.
“You would be more inclined to share risks with patients if the risk is high or immediate and there’s something you can do about it. But I don’t necessarily tell them at the time of diagnosis. It can be too much information at this point, and there might not initially be a lot you can do,” says Dr. Chaim Putterman, an immunology researcher and chief of the Division of Rheumatology at the Albert Einstein College of Medicine and Montefiore Medical Center in New York.
Understanding Autoimmune Disease
Autoimmune disease is still a bit of a mystery. We know that it occurs when the body mistakenly targets and attacks specific tissues and that B and T cells are doing the damage.
We also know that there are more than 80 autoimmune diseases. Some of the most common include:
— Rheumatoid arthritis: an attack on the joints, lung and heart.
— Type 1 diabetes: an attack on insulin-producing beta cells in the pancreas.
— Hashimoto’s thyroiditis: an attack on the thyroid gland (the most common cause of an underactive thyroid).
— Psoriatic arthritis: an attack on the joints and skin.
— Multiple sclerosis: an attack on the central nervous system (the spinal cord, brain and optic nerves).
— Lupus: an attack on the joints, brain, kidneys and skin.
— Vitiligo: an attack on the pigment cells that make color in your skin.
But science remains at the speculation stage when it comes to understanding what causes the immune system to betray the body.
[See: On a Scale From 1 to 10: The Most Painful Medical Conditions.]
Potential Triggers
There are more than 20 genes associated with autoimmune disease. For example, a gene called PTPN22 is linked to several conditions. “One family member might have RA, one might have thyroid disease and one might have lupus. It might be the same gene in each case. That goes a long way toward explaining why autoimmune diseases tend to run in families,” Putterman points out.
But genetics are just part of the equation. Exposure to environmental factors may actually flip the switch to cause an autoimmune condition. “The thinking goes that there’s got to be an environmental trigger to push the immune system in the direction of autoimmunity,” says Dr. Matthew Freeby, an endocrinologist and director of the UCLA Gonda Diabetes Center.
For example, environmental factors associated with triggering multiple sclerosis include vitamin D deficiency, a fatty diet, smoking, the Epstein-Barr virus and reduced sunlight exposure.
But these are only associations, not causes, and so far there’s no conclusive evidence. “We’ve had a number of studies that have looked at gluten or cow’s milk or vitamin D deficiency or gut health, and whether those increase potential risk for Type 1 diabetes. But the science isn’t there for what might be the trigger,” Freeby says.
Complicating this, both doctors say, is that each of us is different, and the particular combination of factors that cause one person to develop an autoimmune condition may not cause another person to get it. In other words, there’s no one recipe for autoimmunity.
[Read: The Doctor Will See You Today.]
The Link to Other Autoimmune Conditions
Also unclear is why someone with one autoimmune condition develops a second and even third autoimmune disease. Studies note that this occurs in about 25 percent of patients. “It’s probably that people with several autoimmune diseases have a particularly susceptible gene pool,” Putterman explains.
Some autoimmune conditions commonly occur with others. For example, multiple sclerosis is associated with autoimmune thyroid disease and psoriasis. And Type 1 diabetes is associated with several autoimmune conditions. “Hypothyroidism is the most common in Type 1 diabetes. We also see vitiligo and celiac disease,” Freeby says.
Having a combination of at least three autoimmune diseases is called multiple autoimmune syndrome, and it makes treatment challenging. “If you have one disease, it might impact another. In Type 1 diabetes, it’s difficult to maintain glucose control, and if we throw in someone with low thyroid levels, it can impact that glucose control,” Freeby says.
[See: 6 Reasons You’re Procrastinating on Your Health Goals — and How to Stop.]
The Encouraging News
Just because you have one autoimmune disease, it doesn’t mean you’ll automatically develop another. And your doctor may not even mention additional risk. “It depends on the disease and the associated risks — if the risk is modifiable or treatable and if the second disease will benefit from early treatment,” Putterman says.
Modifiable risk factors include:
— Smoking cessation: Smoking can exacerbate symptoms of autoimmune disease.
— Stress reduction: Stress can exacerbate symptoms of some autoimmune conditions, such as multiple sclerosis and lupus.
— Diet and exercise: “A healthy lifestyle is the best way of protecting your health, including your immune system,” Putterman notes, although he doesn’t recommend one diet in particular. The U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans recommends 150 minutes per week of moderate intensity activity, such as bicycling slower than 10 miles per hour, general gardening or brisk walking.
None of these lifestyle modifications is proven to prevent or stop autoimmune disease. But together they may help lower your risk for developing another condition.
And doctors say there’s reason to believe that medications may one day cure autoimmunity. “The last decade has seen a revolution in treatment for autoimmune diseases, with medications that can modulate or suppress the immune system in a more targeted way than previously had been available,” Putterman says. “We see much improved prognosis and patient functionality.”
Freeby agrees that the advancements are promising. “I think it’s hopefully just a matter of time,” he says. “We might find something that would positively impact the prevention of autoimmune disease.”
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Have One Autoimmune Disease? You May Be at Risk for Another originally appeared on usnews.com
