Are autoimmune diseases fatal?
Normally, your immune system fights off disease and protects your body from infection. However, when you have an autoimmune disease, your immune system mistakenly attacks healthy cells, tissues and organs, which results in damage to the body.
With more than 100 autoimmune diseases documented, the National Institutes of Health reports that approximately 23.5 million Americans live with these conditions. Although it depends on the type and severity, a majority of autoimmune diseases are not fatal and can be managed with treatment.
“Many autoimmune diseases affect quality of life, but not so much life expectancy,” says Dr. John Varga, a distinguished professor of internal medicine and chief of the rheumatology division at the University of Michigan.
However, without proper management, certain diseases can decrease life expectancy.
How autoimmune diseases affect life expectancy
Many people with autoimmune diseases can continue to live full, normal lives with proper treatment and management of their conditions.
However, depending on the type, severity and response to treatment of the condition, autoimmune diseases can potentially reduce life expectancy due to chronic inflammation and damage caused to various organs and systems within the body. Regular monitoring, proper disease management and adhering to treatment plans play a crucial role in mitigating the impact.
Systemic autoimmune diseases, which are diseases that affect many organs, have a mortality rate of about 15 persons per million of the population, according to a study published in the journal Rheumatology. Their findings suggest that the mortality risk of systemic autoimmune diseases — such as systemic sclerosis, vasculitis, lupus and scleroderma — increases with age, which may be explained by the buildup of damage to vital organs and systems over time.
Often, autoimmune disorders can be an underlying cause of death due to complications caused by multiple comorbidities, meaning they have more than one chronic condition occurring at the same time.
Overlapping autoimmune conditions
To complicate matters, some patients may have more than one autoimmune condition, which can be challenging to manage. For example, myasthenia gravis — an autoimmune disease that affects the skeletal muscles — puts you at risk for other autoimmune diseases, says Dr. Sujata Thawani, an assistant professor in the division of neuromuscular medicine at New York University Langone Health in New York City.
Although research is ongoing, experts suggest it’s possible that genetic risk factors, environmental triggers or an already-vulnerable immune system contribute to a patient having more than one autoimmune disease.
Here are 10 autoimmune diseases that may impact life expectancy:
Autoimmune myocarditis
Autoimmune myocarditis is a rare autoimmune disorder characterized by inflammation in the heart muscle. Unlike viral myocarditis, which could be triggered by viral infections, cancer, bacterial infections and other contagious diseases., the underlying cause of autoimmune myocarditis is unknown.
Symptoms of autoimmune myocarditis
Symptoms of autoimmune myocarditis can come on suddenly and without warning. Symptoms include:
— Abnormal heartbeat
— Shortness of breath
— Fatigue
— Fever
— Headache
Others may not experience any noticeable signs or symptoms. If you experience symptoms that present like a heart attack, it’s important to seek medical attention immediately for treatment and to evaluate possible causes, including the possibility of myocarditis. Although rare, myocarditis is associated with an increased risk of sudden cardiac death in young adults, including competitive athletes.
Treatment for autoimmune myocarditis
When it’s diagnosed, drugs that suppress the immune system may be used to treat autoimmune myocarditis.
Multiple sclerosis
Nearly 1 million people in the U.S. are living with multiple sclerosis, according to a study funded by the National Multiple Sclerosis Society. This autoimmune disorder, which affects the brain and spinal cord, results from the immune system mistakenly attacking a protective layer around the nerves, called the myelin sheath, and disrupts the communication between the brain and the rest of your body, causing a range of problems.
Research, including a long-term study published in 2017, suggests people with MS live an average of seven years less than those without MS. Those with MS had a median age of survival of about 76 years compared to 83 years for a matched general population, according to another study.
Symptoms of multiple sclerosis
Symptoms of MS include:
— Difficulty with coordination and balance
— Spasticity, commonly in the legs
— Fatigue
— Memory issues
— Weakness
— Bladder dysfunction and bowel problems
Treatment for multiple sclerosis
Although there is currently no cure for MS, advancements in MS treatments continue to improve symptoms and life expectancy for those living with the disease.
Treatment typically focuses on preventing the permanent damage that can occur in the central nervous system early in the disease. This can be combined with symptom management, physical therapy and maintaining a healthy lifestyle, including following a nutritious diet.
Among other treatment options, drug therapies targeting B cells — a type of white blood cell used by the body’s immune system — have shown promise.
“B cell depletion therapy has been phenomenal for many patients with multiple sclerosis and is now standard of care, which it certainly wasn’t some years ago,” says Dr. Betty Diamond, director of the Institute of Molecular Medicine at the Feinstein Institutes for Medical Research at Northwell Health in Manhasset, New York.
Lupus
An estimated 1 million to 1.5 million people in the U.S. have lupus, an autoimmune condition characterized by facial rashes, continual fatigue and joint pain. About 90% of adults with lupus are women, according to the Centers for Disease Control and Prevention.
As with other autoimmune conditions, various factors impact life expectancy for people with lupus, including ethnicity. In the U.S., lupus mortality is higher in Black, Hispanic and Asian populations.
Symptoms of lupus
Symptoms of lupus can vary widely among individuals with the condition, and symptoms may come and go. Common symptoms of lupus include:
— Joint pain, stiffness and swelling
— Skin rashes, particularly a butterfly-shaped rash across the cheeks and nose, called a malar rash
— Persistent, overwhelming fatigue
— Low-grade fever
— Photosensitivity
— Numbness or change in color of fingers and toes in reaction to cold or stress, called Raynaud’s phenomenon
— Swelling
— Headaches or dizziness
Treatment for lupus
Because lupus causes your body’s immune system to mistakenly attack itself, immunosuppressive therapies work to lower this response. However, therapies that suppress the immune system also put patients at a higher risk of infection — a cause of death in some patients with lupus. That’s why having better antibiotics and treatments for some of those infectious complications have also positively impacted survival rates for people with lupus.
In addition to treating the autoimmune disorder itself, clinicians have to be mindful of treating other health problems caused by or related to the autoimmune disorder.
The most common type of lupus, systemic lupus erythematosus, causes widespread inflammation in the body, which can lead to problems in several organs. This may include:
— Kidney (lupus nephritis)
— Heart. If you have lupus, you may be more likely to develop cardiovascular disease.
— Brain and central nervous system, causing seizures or memory problems
Advancements in treatment of kidney disease, including the availability of kidneys for transplant, has helped improve the outlook for many with lupus.
Type 1 diabetes
Commonly diagnosed in kids, Type 1 diabetes is an autoimmune disease in which the immune system attacks the pancreas and prevents the body from making the insulin needed to properly control blood sugar.
Although it’s unclear what causes Type 1 diabetes, experts believe it can develop due to genetics, an infection or another trigger.
Symptoms of Type 1 diabetes
Symptoms of Type 1 diabetes include:
— Feeling very thirsty or hungry
— Severe fatigue
— Blurred vision
— Nausea, vomiting or stomach pains
— Unintentional weight loss
For those with Type 1 diabetes, symptom onset can be very sudden. The individual may experience severe signs signaling a need for immediate medical attention, called diabetic ketoacidosis, or DKA.
Treatment for Type 1 diabetes
There isn’t a cure for Type 1 diabetes, but those with well-controlled diabetes can live long, full lives and have a good quality of life. Living with Type 1 diabetes includes managing the disease with insulin to keep blood sugar within a healthy range rather than suppressing the immune system and maintaining a healthy lifestyle, including a nutritious, well-balanced diet to control carbohydrate consumption and regular exercise.
However, if the disease is not well-managed, it can cause a variety of serious complications, including kidney and heart disease, eye disease (diabetic retinopathy) and nerve problems.
Vasculitis
Vasculitis is an autoimmune disease in which the body’s immune system attacks the blood vessels and causes inflammation. It can occur on its own or be caused by other autoimmune disorders, like lupus or rheumatoid arthritis.
Severe forms of vasculitis can be life-threatening, according to Dr. Ignacio Sanz, chief of the division of rheumatology at Emory University School of Medicine and director of the Lowance Center for Human Immunology at Emory University and Children’s Healthcare of Atlanta. Vasculitis has the potential to cause damage to your organs or lead to blood clots.
Symptoms of vasculitis
Symptoms of vasculitis can vary depending on the type and severity of the autoimmune disorder and by the affected blood vessels and organs. Symptoms can range from mild to severe, and include:
— Tiredness or fatigue
— Low-grade fever
— Muscle and joint aches and pain
— Weight loss
— Loss of appetite
Vasculitis can cause a range of complications, such as:
— Ear, nose and eye problems, like sinus infections, hearing loss or changes in vision
— Gastrointestinal issues, such as diarrhea or stomach pain
— Skin problems, like rashes or ulcers
— Heart palpitations
— Nerve problems, like numbness, tingling or shooting pains
Treatment of vasculitis
Vasculitis treatment involves using medications like corticosteroids to control inflammation and address any underlying disease. Biologic therapies may be used to deal with immune system issues that contribute to the condition.
To prevent infections that can occur when immunosuppressive treatments are used for any autoimmune disorder, patients are encouraged to stay up to date on vaccinations. That includes getting vaccinated to prevent the flu, shingles and pneumonia, as recommended by a doctor. You should also ask your doctor if receiving the COVID-19 vaccine is right for you and your particular autoimmune disease.
Myasthenia gravis
Myasthenia gravis is an autoimmune neuromuscular disease that causes muscular weakness. There are approximately 36,000 to 60,000 estimated cases in the U.S., but the disease is underdiagnosed and prevalence is likely higher, according to the Myasthenia Gravis Foundation of America.
“It’s considered a disease of the neuromuscular junction,” Thawani says. “It’s the space in which a muscle and a nerve are communicating. There’s a disconnect between that communication.”
Key proteins in the muscles are not getting appropriate signals from the nerve terminal, or nerve ending. As a result, the muscle gets fatigued more easily and becomes weaker.
Patients with myasthenia gravis can take steps to improve their outcomes, Thawani says. That includes getting their bone density checked regularly if they’re on chronic steroids, and also using vitamin D and calcium supplements, as well as getting moderate exercise, maintaining a healthy weight and not smoking. Fatigue is common in patients with this disease, and addressing mental health is also important.
“Most people can have a normal life expectancy,” Thawani says. “MG has a prognosis of less than 5% mortality. Fifteen percent of people with MG can develop a myasthenic crisis, in which they develop severe weakness of respiratory muscles that leads to prompt treatment in an intensive care setting.”
Symptoms of myasthenia gravis
Myasthenia gravis affects certain muscle groups, including:
— Ocular muscles that control eye movements and the eyelids
— Muscles in the larynx and pharynx involved with swallowing and speech
— Head and neck muscles that provide support
— Limb muscles, shoulder and hip girdle, muscles of the hands and feet
Certain myasthenia gravis symptoms — such as eye pain and weakness in the arms and legs — may appear similar to MS. However, unlike MS, a person may also experience droopy eyelids, difficulty speaking and swallowing, slurred speech and trouble making facial expressions.
Treatment for myasthenia gravis
Primary treatment for myasthenia gravis is immunosuppressive drugs. However, 15% of patients have very treatment-resistant myasthenia gravis, which can be due to having associated muscular specific kinase (MuSK) antibodies, tumors of the thymus gland (thymomas) and complex comorbid conditions.
Rheumatoid arthritis
Rheumatoid arthritis mainly attacks your joints, commonly affecting the hands, wrists and knees, as well as the neck. Affected joints become inflamed, causing damage to the joint tissue which can lead to long-lasting pain, trouble with balance and deformity of joints.
The joint disease affects up to 1% of the population, predominantly women, and can raise the risk for heart disease and lung disease, which may be attributed to systemic inflammation, according to a peer-reviewed study published in American Heart Journal. Based on research to date, having RA may decrease life expectancy by a decade or more. However, as with other autoimmune diseases, life span varies greatly among individuals with RA.
Symptoms of rheumatoid arthritis
RA symptoms can come and go. Those with RA may experience “flares,” which are periods when their symptoms get worse, followed by remission when symptoms improve. Symptoms of RA include:
— Joint pain or aches
— Joint stiffness
— Joint tenderness or swelling
— Weight loss
— Fever
— Fatigue
— Weakness
With rheumatoid arthritis, you’ll experience pain, stiffness or swelling in more than one joint.
Treatment for rheumatoid arthritis
Proper management of the disease can improve a person’s outlook. Treatment often includes the use of disease-modifying antirheumatic drugs (DMARDs) and lifestyle changes to manage arthritis symptoms, including following a plant-based diet.
Managing RA symptoms to improve daily living may include:
— Using a heating pad to ease joint discomfort
— Taking pain relievers to ease pain
— Incorporate physical activity. Low-impact exercises, like walking or swimming, may be easier on the joints.
— Maintaining a healthy weight
Psoriasis
Just as rheumatoid arthritis can impact health well beyond inflaming joints, psoriasis is more than a skin disease. The autoimmune disorder is also associated with other serious issues, including an increased risk of diabetes, depression and heart disease.
As a result, depending on the severity of psoriasis, it may affect life expectancy and raise mortality risk. In a population-based cohort study of more than 3,600 patients in the U.K., researchers found that patients with severe psoriasis had an increased risk of death from a variety of causes, with cardiovascular death being the most common cause. Additionally, the study showed a significant increased risk of death associated with kidney disease, infection and dementia in patients with severe psoriasis.
Symptoms of psoriasis
Psoriasis happens when an overactive immune system causes skin cells to multiply too quickly. Psoriasis symptoms that result include:
— Dry, cracked skin
— Thick, red, patchy skin with silvery-white scales
— Itchy or burning patches
Those with psoriasis may go through periods of flares that can last from weeks to months, followed by periods of remission.
Treatment for psoriasis
Mild psoriasis may be treated successfully with topical therapies, such as corticosteroids creams or ointments, while moderate to severe cases of the disease may require pills, injections or phototherapy — a dermatologist-prescribed treatment that involves applying ultraviolet light to your skin.
Scleroderma
Also referred to as systemic sclerosis, scleroderma is an autoimmune disease that causes thick, tight, hardened skin and can affect connective tissue and internal organs. Scleroderma is considered fairly rare, affecting an estimated 75,000 to 100,000 people in the U.S., mostly women between the ages of 30 and 50, according to the American College of Rheumatology.
“Scleroderma causes scarring in the lungs and scarring of the blood vessels, and both of those are leading causes of death. When that happens, which it does in a lot of patients, their life expectancy is pretty significantly affected,” Varga says.
Survival estimates vary. For severe scleroderma, five-year survival rates range from about 75% to 80% but decrease significantly with each decade after diagnosis. For patients with localized disease, five-year survival is estimated at about 90%.
Symptoms of scleroderma
Symptoms of the disease can vary, particularly depending on the type of scleroderma you have.
— Localized scleroderma mainly affects the skin. The disease causes thick, hard skin patches, either in oval-shaped areas (morphea) or lines down your arms, legs or sometimes, forehead (linear).
— Systemic scleroderma causes scarring and inflammation that can result in permanent damage to the kidneys, lungs, digestive system and other parts of the body, as well as thickening of the skin. Fatigue is common with systemic scleroderma.
Treatment for scleroderma
There is no known cure for scleroderma, but there are treatments for relieving symptoms and preventing complications. Treatments include:
— Topical creams and ointments
— Phototherapy
— Immunosuppressive drugs
— Physical and/or occupational therapy
Mixed connective tissue disease
Mixed connective tissue disease (MCTD) is a rare autoimmune disease that can often be life-threatening. MCTD is sometimes called an overlap disease because it frequently mimics symptoms from other autoimmune disorders, including lupus, rheumatoid arthritis, scleroderma and myositis.
Symptoms of mixed connective tissue disease
Early signs of the disease may include:
— Arthritis, or inflamed or swollen fingers or joints
— Muscle weakness and fatigue
— Shortness of breath and dry cough
— Difficulty swallowing
— Rash
According to the Arthritis Foundation, nearly everyone with MCTD has aching joints and the disease also inflames muscle fibers. Complications of the disease may include:
— High blood pressure that affects blood vessels in the lungs, which is also known as pulmonary hypertension
— Heart or lung disease
— Kidney damage
— Anemia
Treatment for mixed connective tissue disease
Many patients with MCTD can manage and treat symptoms from the disease. In fact, nearly one-third of patients undergo complete resolution of the disease.
However, one-third can develop serious life-threatening complications. According to a study on the survival rate and prognostic indicators of MCTD in Hungary, pulmonary arterial hypertension was the leading cause of death in patients with MCTD. The survival rates at five, 10 and 15 years after diagnosis were 98%, 96% and 88%, respectively.
Advances in treatments mean many with autoimmune diseases now live longer.
While disease severity varies, advances in medical treatments for autoimmune diseases have greatly bolstered life expectancy and improved quality of life for many patients. Therapeutic breakthroughs include biological drugs that suppress the immune system activity driving a myriad of health problems for those with autoimmune diseases, such as lupus and multiple sclerosis.
In addition, researchers are exploring the use of chimeric antigen receptor (CAR) T-cell therapy, a type of immunotherapy that uses the immune system to fight diseases.
While CAR-T cell therapy has primarily been used as a cancer treatment by genetically modifying a patient’s T cells (a type of white blood cell) to recognize and attack cancer cells, it may be a potential therapeutic strategy for autoimmune diseases as well. Several clinical trials are underway to explore CAR-T therapies for treating autoimmune diseases, and early results are promising — especially for lupus and scleroderma, according to Varga.
Managing autoimmune diseases
Frequently, as with other disease prevention and management, a combination of lifestyle improvements — like eating well, exercising regularly and getting adequate sleep — and medical management are recommended.
Because of the many overlapping symptoms and complexities of autoimmune diseases, some people may face challenges in receiving a prompt and accurate diagnosis.
“The most important thing is to find a physician who’s knowledgeable and experienced and with whom you work well, and together work out a treatment regimen that works for you,” Diamond says.
Depending on your condition, your symptoms may affect different systems of the body. Therefore, managing your autoimmune disease may mean seeing different types of specialists, such as:
— Dermatologist. Dermatologists may treat autoimmune diseases that predominantly affect your skin, such as psoriasis or scleroderma.
— Endocrinologist. Endocrinologists specialize in diseases related to your hormones. You may see an endocrinologist if you have certain autoimmune diseases like Type 1 diabetes.
— Rheumatologist. Rheumatologists specialize in treating arthritis and other inflammatory and immune-related disorders. Rheumatologists may treat autoimmune conditions such as lupus or rheumatoid arthritis.
Autoimmune disease list
Autoimmune conditions that may affect life expectancy:
— Autoimmune myocarditis
— Multiple sclerosis
— Lupus
— Type 1 diabetes
— Vasculitis
— Myasthenia gravis
— Rheumatoid arthritis
— Psoriasis
— Scleroderma
— Mixed connective tissue disease
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10 Potentially Fatal Autoimmune Diseases: Symptoms, Diagnosis and Treatment originally appeared on usnews.com
