Autoimmune Diseases
The immune system protects the body against disease and infection, but sometimes it can produce autoantibodies that attack healthy cells, tissues and organs. This can lead to autoimmune diseases. Autoimmune diseases (AIDs) are a group of complex disorders of unknown cause in which the immune system reacts against self-antigens. They are thought to result from interactions between genetic and environmental factors¹. Autoimmunity contributes to more than 100 serious chronic diseases involving nearly every organ system in the body. Almost all autoimmune diseases affect women more often than men. Some are among the ten leading causes of death in women under 65 years of age, and collectively they represent the fourth leading cause of disability among women in the United States².
A Brief History
During the 20th century, the concept of autoimmunity began to emerge. By the 1940s, it was considered a plausible cause of disease. In 1992, only 67 autoimmune diseases had been identified. Today, more than 100 are recognized, and it is estimated that around 50 million Americans live with autoimmunity, including 30 million women. The numbers have continued to rise over the past decade². Many of these diseases are becoming more common in industrialized countries. Treatment of autoimmune diseases improved considerably during the second half of the 20th century, but progress has been limited by the fact that disease processes often begin before a clinical diagnosis is possible. A close interaction between environmental triggers and genetic factors appears to contribute to loss of immune tolerance and autoimmunity. Future research aims to clarify the links between genetic predisposition and environmental triggers.
Life-Threatening and Disabling Diseases
Some autoimmune diseases are life-threatening, and most are disabling and require lifelong management. Treatments can reduce symptoms and disease effects in many autoimmune conditions, but no cure has yet been identified. Because most autoimmune diseases are rare, patients may spend many years before receiving the correct diagnosis.
Environmental and Lifestyle Risks in Autoimmune Diseases
Physical Activity
A 2018 review of physical activity found that exercise is a safe option for most autoimmune diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), multiple sclerosis (MS), inflammatory bowel disease (IBD), and others. In addition, the prevalence of RA, MS, IBD and psoriasis has been shown to be higher in less physically active patients. Overall, people with autoimmune diseases are more sedentary than the general population. Physically active patients with RA tend to have milder disease, a better cardiovascular risk profile and improved joint mobility. Physical activity can reduce fatigue and improve mood, cognition and mobility in people with MS. In patients with SLE, higher activity levels are associated with better quality of life and a more favorable cardiovascular profile. Physically active people with type 1 diabetes mellitus have a lower risk of autonomic neuropathy and cardiovascular disease (CVD). Patients with fibromyalgia and systemic sclerosis report milder disease, less pain and better quality of life with higher activity levels[4]. A 2015 orthopedic review emphasized that inactivity in patients with rheumatic disease is highly detrimental both physically, through reduced muscle strength, poorer fitness and increased stiffness, and psychologically, through fear of movement, depression and loss of confidence. Exercise can therefore play an important role in the management of rheumatic disease by optimizing both physical and mental health, increasing energy levels, reducing fatigue and improving sleep[5].
Obesity
Obesity is a major environmental factor that appears to contribute to both the development and progression of autoimmune disease. Adipose tissue produces a range of adipokines involved in the regulation of many physiological functions, including immune activity. Strong evidence indicates that people with obesity have an increased risk of diseases such as RA, MS, psoriasis and psoriatic arthritis (PsA). Obesity has also been associated with a higher risk of inflammatory bowel disease (IBD), type 1 diabetes (T1D) and thyroid autoimmunity (TAI). In addition, obesity can worsen the course of RA, SLE, IBD, psoriasis and PsA and may reduce treatment response in these conditions[6].
Stress
Stress management should form part of autoimmune disease care because stress is likely to be a contributing factor. Many patients with autoimmune disease report unusually high stress levels before disease onset or exacerbation[7].
Smoking
Smoking is clearly associated with the development of several autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, Graves' hyperthyroidism and primary biliary cirrhosis, among others[8].
Toxins
A 2012 study of environmental exposures and autoimmune disease concluded that:
Exposure to crystalline silica may contribute to the development of several autoimmune diseases, for example in glass, granite and stone-cutting work where employees are exposed to silica dust.
Solvent exposure may contribute to the development of systemic sclerosis.
Smoking may contribute to the development of seropositive rheumatoid arthritis.
There is an inverse association between ultraviolet radiation exposure and the risk of developing multiple sclerosis.
Drug-Induced Autoimmune Syndromes
The number and complexity of drug-induced autoimmune syndromes have increased, and many are now associated with autoantibodies that were previously thought to be limited to idiopathic disease states[9].
Diet
Diet, nutrition, oral hygiene, exercise and BMI may also play a role in the development of autoimmune disease. A 2019 study reported a potential association between pork consumption and autoimmunity in humans[10].
Oral Manifestations
Autoimmune diseases can frequently manifest in the oral cavity, meaning dentists may play an important role in detecting these diseases and supporting further interdisciplinary management[11].
Physiotherapy
Physiotherapists are well placed to address many of the contributing factors and current functional problems experienced by patients with autoimmune diseases. Medication alone has limited ability to address these physical and lifestyle-related challenges.
Physical activity: Plan, implement and follow up exercise programs; encourage appropriate choices, for example working toward 30 minutes of walking three times per week; and educate patients that progress may be gradual but can still be worthwhile.
Diet: Provide advice and education about healthy food choices and portion sizes, with referral to other professionals when appropriate.
Toxin avoidance: Smoking is an obvious example, and awareness of the risks associated with second-hand smoke is also important.
Stress: When appropriate, teach stress-reduction strategies such as yoga, cognitive behavioral therapy (CBT), Tai Chi, breathing control and meditation.
Sources:
Miller FW, Alfredsson L, Costenbader KH, Kamen DL, Nelson LM, Norris JM, De Roos AJ. Epidemiology of environmental exposures and human autoimmune diseases: findings from a National Institute of Environmental Health Sciences Expert Panel Workshop. Journal of autoimmunity. 2012 Dec 1;39(4):259-71. https://www.ncbi.nlm.nih.gov/pubmed/22739348 (
Amy Scanlin, MS. Autoimmune disease: The growing impact.BioSupply Trends Quarterly April 2014 p47 : http://www.bstquarterly.com/Assets/downloads/BSTQ/Articles/BSTQ_2014-04_AR_Autoimmune-Disease-The-Growing-Impact.pdf
Sharif K, Watad A, Bragazzi NL, Lichtbroun M, Amital H, Shoenfeld Y. Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmunity reviews. 2018 Jan 1;17(1):53-72.https://www.ncbi.nlm.nih.gov/pubmed/29108826
Sharif K, Watad A, Bragazzi NL, Lichtbroun M, Amital H, Shoenfeld Y. Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmunity reviews. 2018 Jan 1;17(1):53-72.: https://www.ncbi.nlm.nih.gov/pubmed/29108826 ↑ Musumeci G. Effects of exercise on physical limitations and fatigue in rheumatic diseases. World journal of orthopedics. 2015 Nov 18;6(10):762.: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644863/
Lago F, Dieguez C, Gómez-Reino J, Gualillo O. The emerging role of adipokines as mediators of inflammation and immune responses. Cytokine & growth factor reviews. 2007 Jun 1;18(3-4):313-25. : https://www.ncbi.nlm.nih.gov/pubmed/25092612
Stojanovich L. Stress and autoimmunity. Autoimmunity reviews. 2010 Mar 1;9(5):A271-6. : https://www.ncbi.nlm.nih.gov/pubmed/23182292
Costenbader KH, Karlson EW. Cigarette smoking and autoimmune disease: what can we learn from epidemiology?. Lupus. 2006 Nov;15(11):737-45. Available from: https://journals.sagepub.com/doi/10.1177/0961203306069344 (last accessed 29.9.2019)
Olsen NJ. Drug-induced autoimmunity. Best Practice & Research Clinical Rheumatology. 2004 Oct 1;18(5):677-88. Available from:https://www.ncbi.nlm.nih.gov/pubmed/15454126 (last accessed 30.9.2019)
Gershteyn IM, Ferreira LM. Immunodietica: A data-driven approach to investigate interactions between diet and autoimmune disorders. Journal of Translational Autoimmunity. 2019 Jun 6:100003. From: https://www.biorxiv.org/content/10.1101/619700v1
Saccucci M, Di Carlo G, Bossù M, Giovarruscio F, Salucci A, Polimeni A. Autoimmune diseases and their manifestations on oral cavity: diagnosis and clinical management. Journal of immunology research. 2018;2018. : https://www.hindawi.com/journals/jir/2018/6061825/
