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Autoimmune Diseases on the Rise
March  2017

In this issue of Housecalls Dr. Regina Rosace presents a case of Attention Deficit Hyperactivity Disorder (ADHD) while I discuss a case of Granulomatosis with Polyangiitis (GPA). GPA is a rare autoimmune disease that can damage several major organ systems.

Unfortunately, autoimmune diseases are on the increase in many parts of the world. Autoimmune diseases result from a pathologic attack by the body’s immune system against an antigen present as part of the molecular structure of the host. Autoantibodies are not uncommon in immunologically intact people, and even with autoimmune diseases, they can exist for many years prior to the onset of disease.

Studies in identical twins indicate that underlying genetically heritable traits account for less than half of the susceptibility to autoimmune diseases. Epigenetic influences on gene expression, infections, environmental factors and even the personal microbiota have all been shown to influence the development of various autoimmune diseases. Examples
of diseases with actual or presumed autoimmune basis are Type 1 diabetes, systemic lupus erythematosus, myasthenia gravis, autoimmune thyroiditis, autoimmune hepatitis, bullous pemphigoid, celiac disease, GPA, etc.

A recent review of 30 articles revealed an estimated annual percent increase in rheumatic, endocrine, gastrointestinal and neurological autoimmune disease of 7.1, 6.3, 6.2 and 3.7%, respectively. If there is any bright spot in this trend of increasing autoimmune diseases it is the development of better immunosuppressive and immune modulating drugs. Newer biologic agents are targeting specific inflammatory and immune reactions, thereby lessening the potential damage to healthy tissue. Meanwhile the genetics, precursors, causes and triggers of autoimmune disease is an active area of medical research.

Resources
Bach J, “The Effect of Infections on Susceptibility to Autoimmune and Allergic
Diseases,” N Engl J Med 2002; 347:911-920.
Lerner A, et al, “The World Incidence and Prevalence of Autoimmune Diseases is
Increasing” Int J of Celiac Dis 2015;3(4):151-155