Unexplained Pain: Is It an Autoimmune Disease?

Learn the Symptoms and Treatments of 6 Common Autoimmune Diseases

By Emily Dwass, Special to Lifescript
Published January 31, 2013
Reviewed By By Edward C. Geehr, M.D.

Are you exhausted and depressed? Do your joints ache? These are telltale symptoms of more than 80 of the autoimmune diseases that exist. Find out the 6 most common, what happens when your body turns against itself and how to diagnose and treat symptoms...

When our immune systems work right, our body is able to fend off attacks from invading bacteria and viruses.

But with an autoimmune disease, it fights against us. Instead of protecting, it attacks, sending armies of your body’s disease-fighters to battle your own healthy tissue, cells and organs.

Up to 22 million Americans have autoimmune disorders, according to the National Institutes of Health (NIH). Nearly 80% of them are women — many in their childbearing years, according to the Centers for Disease Control and Prevention (CDC). And the numbers are growing.

“Autoimmune diseases are much more prevalent now than they were 20 years ago,” says Virginia Ladd, president of the American Autoimmune Related Diseases Association. “Each disease is relatively rare, but looking at them collectively, that’s another story.”

Why the increase? Unfortunately, that’s a medical mystery. Researchers suspect genetics, infection and the environment are triggers.

Just as the causes are puzzle, so are the symptoms. If they appear together, three major red flags signal an autoimmune disease: joint pain, fatigue and depression, says health educator Rita Baron-Faust, M.P.H., co-author of The Autoimmune Connection: Essential Information for Women on Diagnosis, Treatment, and Getting on With Your Life (McGraw-Hill).

But many other different signs also can point to an autoimmune disease. The tipoff for type 1 diabetes, for example, is excessive thirst and frequent peeing. Hair loss is a symptom of lupus.

The Big 6: What You Can Do

More than 80 autoimmune diseases exist, according to the NIH. Here’s a look at the 6 most common:

1. Rheumatoid Arthritis (RA)
About 1.3 million Americans — adults and children — have this incurable chronic disorder, and 75% of them are women, the NIH reports.

With RA, the immune system’s white blood cells attack the joint lining, causing inflammation, redness, warmth and pain. Joint damage usually appears in the first two years. Over time, the cartilage and bone destruction can cripple sufferers.

Symptoms include:
• Pain in the wrists and fingers of both hands
• Tender, warm joints in both knees and elbows
• Morning discomfort
• Fatigue/loss of energy
• Fever

How to diagnose it: Because there’s no definitive lab test and symptoms are often slow to appear, RA is difficult to diagnose. Symptoms may seem vague. A woman simply might feel under the weather and have pain in her hands or feet.

Ultimately, you’ll need a combination of lab and physical exams to pinpoint RA. Blood tests can detect the presence of rheumatoid factor (RF) antibodies, but not all affected people test positive. X-rays also can track joint damage over months or years.

How to treat it: Over-the-counter anti-inflammatory drugs such as ibuprofen (Advil or Motrin) may ease mild symptoms, Baron-Faust says.

If joint damage, aches or pain get worse, you may need disease-modifying anti-rheumatic drugs (DMRADs), such as Methotrexate. In the short-term, corticosteroids may reduce pain and inflammation, but they have serious side effects, such as infection.

Newer biologic response modifiers (Humira, Enbrel, Remicade) may help those who don’t respond to other treatments, but these also increase the risk for infections and lymphoma.

Though it can be hard to manage, mild to moderate exercise is also recommended because it can strengthen muscles, increase mobility and reduce depression. To find classes, contact the Arthritis Foundation ( 800-283-7800 ) or the YMCA ( 800-872-9622 ).

Research also shows that some supplements, such as omega-3 fatty acid, may help improve symptoms. But consult your doctor before turning to alternative methods.

2. Type 1 Diabetes
Surprised that type 1 diabetes is an autoimmune disease? It's often lumped together with type 2 diabetes, but type 2 isn’t an autoimmune disease.

With type 1, autoantibodies target the insulin-secreting beta cells of the pancreas. Insulin regulates blood sugar levels and the 3 million Americans with type 1 lack the hormone to begin with, says Walter Gaman, M.D., of Executive Medicine of Texas, a practice in Southlake.

People with type 2 diabetes are resistant to insulin, but produce it.

When too much sugar accumulates in the blood, the kidneys go into over-drive to get rid of it. This is why the most common early symptoms both types of diabetes are excessive thirst and frequent urination.

Others include:

• Fatigue
• Vision problems
• Unexplained weight loss
• Chronic vaginal yeast infections

How to treat it: Unlike other autoimmune diseases, type 1 is easily diagnosed by a urinalysis and a fasting blood glucose test.

People with type 1 diabetes must monitor blood sugar levels daily and control them with insulin (administered by injection or pump). A healthy diet and exercise also work to regulate blood sugar.

Uncontrolled, the disease can lead to lead to kidney damage, heart disease, blindness and stroke.

3. Lupus
The Lupus Foundation estimates that 1.5 million Americans have the disease, which hits women about 10 times more often than men.

Lupus attacks tissue and organs and may damage joints, kidneys, blood cells, skin, the heart, lungs — even your brain.

Like snowflakes, no two cases of this chronic inflammatory disease are alike. It’s difficult to diagnose because “there’s a spectrum of different manifestations, complaints, signs and symptoms,” says Susan Manzi, M.D., M.P.H., director of the Lupus Center of Excellence at the University of Pittsburgh Medical Center.

On average, a patient may see four doctors before receiving an accurate diagnosis, she says.

The doctor to see? A rheumatologist.

The first sign may be a butterfly-shaped rash across the cheeks and nose. But women often experience extreme discomfort and puzzling symptoms, which sometimes fade and reappear in episodes known as “flares.”

Other common symptoms:

• Achy and swollen joints
• Aches and fatigue
• Fever
• Anemia
• Hair loss
• Mouth and nose ulcers
• Raynaud’s phenomenon (fingers and toes turn white or blue in the cold)
• Easy bruising
• Anxiety or depression
• Shortness of breath or chest pain
• Skin sores from sun exposure

How to treat it: Medications that “quiet down the immune system” may keep symptoms manageable and prevent flare-ups, Dr. Manzi says.

For patients with mild symptoms, the anti-malarial drug Plaquenil can ease inflammation. For moderate symptoms, the steroid prednisone — a powerful anti-inflammatory and immune system suppressor — is often prescribed, though it may increase the risk for infections, osteoporosis and other disfiguring side effects.

Chemotherapy and transplant anti-rejection drugs may help patients with complications such as kidney disease or brain disorders, including memory loss and seizures.

In 2011, Benlysta was approved by the Food and Drug Administration to treat lupus.

Lupus patients have a much higher risk of heart disease, so exercise, a healthy diet and weight and stress management are important.

Also avoid the sun, because ultraviolet light can trigger flares.

4. Inflammatory Bowel Disease (IBD)
IBD includes Crohn’s disease and ulcerative colitis (UC), both painful, chronic conditions that attack the digestive system.

UC causes inflammation in the large intestine; Crohn’s causes sores and ulcerations anywhere in the gastrointestinal tract, from the mouth down, says Ann Silverman, M.D., director of the Henry Ford Center for Inflammatory Bowel Disease in Detroit, Mich.

With IBD, the immune system mistakes normal bacteria in the intestines as foreign bodies. It responds by flooding the intestines with too many white blood cells, which causes the inflammation.

With chronic inflammation, the digestive tract can be damaged or infected with ulcerations, fistulas and abscesses, which result in rectal bleeding, abdominal pain and diarrhea.

UC patients almost always have rectal bleeding, but that’s not always the case for those with Crohn’s; it depends on what area of the GI tract is affected.

In severe cases, life-threatening perforations of the intestines and hemorrhages may need emergency surgery and blood transfusions.

Inflammatory bowel disease “can look completely different in different patients,” Dr. Silverman says.

It isn’t easy to diagnose because symptoms often are confused with irritable bowel syndrome (IBS), which is also characterized by diarrhea and/or constipation. IBS isn’t an autoimmune disease.

So how can you tell? Waking up at night for a bowel movement, blood in the stool and anemia indicate that the problem is more severe than IBS, Dr. Silverman says.

Crohn’s disease and UC are believed to be caused by a genetic predisposition and outside triggers, such as a salmonella infection.

“If a patient has been someplace like Mexico, you check for amobas or a toxin,” Dr. Silverman says.

“Some people start out with an infection, get better and relapse.”

The infection disappears, but inflammation of the colon remains, she says.

Symptoms of Crohn’s and UC include:

• Abdominal pain
• Frequent diarrhea
• Nausea and vomiting
• Fever
• Anemia
• Weight loss
• Night sweats
• Joint pain
• Ulcerations throughout the digestive tract
• Blood in the stool

How to treat it: You’ll need to see a gastroenterologist. Besides taking a thorough medical history and doing a physical exam to determine if the abdomen is inflamed or tender, the specialist also should examine the anorectal area for hemorrhoids, fissures, abscesses or fistulas.

A blood chemistry profile can turn up anemia from intestinal bleeding and the presence of white blood cells, indicating infection or inflammation.

Among the diagnostic tests you may have:

• Flexible sigmoidoscopy, in which a lighted, bendable tube is inserted into the anus and colon. A small camera transmits images to a computer screen, allowing the doctor to see inflamed tissue and other abnormalities.

• Barium X-ray, in which a patient swallows the metallic chemical barium sulfate and has X-rays taken of the GI tract.

• Colonoscopy, in which a long, lighted scope is guided into the colon.

Depending on the disease’s severity, anti-inflammatory drugs, corticosteroids, antibiotics and immune system suppressors, may be prescribed. Surgery is an option for chronic blockages or bleeding.

Because IBD can hinder the absorption of some essential nutrients, you may need vitamins D, A, K or B12 supplements.

There’s no concrete evidence that diet makes a difference with inflammatory bowel disease, but many sufferers find some relief by avoiding:

• Dairy products
• Raw fruits and vegetables
• Gassy foods like beans and broccoli
• Spicy foods
• Alcohol
• Caffeine

5. Sjogren’s Syndrome
With Sjogren’s Syndrome, immune cells attack and destroy the glands that produce tears and saliva, according to the National Institute of Neurological Disorders and Stroke.

About 4 million Americans have Sjogren’s — women are nine times more likely than men to be affected.

At its worst, the disorder damages the kidneys, lungs, liver, pancreas and brain. It frequently causes arthritis and fatigue, and less commonly, nervous system disorders, inflammation of the blood vessels and airways, and lung disease, says Aryeh Fischer, M.D., co-director of the Autoimmune Lung Center of the Division of Rheumatology and ILD Program at National Jewish Health in Denver, Colo.

Lymph nodes may swell and those with Sjogren’s have a higher risk of lymphoma.

“We don’t know why people develop Sjogren’s,” Dr. Fischer says. “It’s probably a combination of genetic and environmental interactions.”

Nearly everyone with Sjogren’s has dry eyes and mouth.

“It’s important to distinguish it from dry eyes alone, because that symptom is so common in the general population,” Dr. Fischer says.

The disorder sometimes accompanies other autoimmune diseases, most commonly rheumatoid arthritis and lupus.

Other symptoms:

• Fatigue
• Joint pain
• Dry cough
• Vaginal dryness
• Dry skin and rashes
• Changed sense of taste
• Enlarged salivary glands
• Dental cavities
• Difficulty swallowing

How to treat it: Women often discover they have Sjogren’s at the dentist or eye doctor, because mucous membranes and glands in the eyes and mouth show early symptoms.

Optical tests can evaluate tear production and determine if chronic dry eye has damaged the cornea.

A urinalysis can detect kidney problems and blood tests can confirm inflammation. But to be classified as Sjogren’s, a doctor must confirm autoimmunity – either by the presence of antibodies or by a salivary gland biopsy, Dr. Fischer says.

Unfortunately, there’s no quick fix for dysfunctional glands. Special eyedrops, drinking more liquids, moisturizers and vaginal lubricants can help ease dryness.

Prescription medications can increase saliva flow to keep the mouth moist and reduce cavities.

Your doctor may recommend over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen) for joint pain, as well as the anti-malarial Plaquenil.

Immunosuppressants, such as Methotrexate, can treat complications in the lungs, blood vessel or central nervous system. Drugs used to treat rheumatoid arthritis also can help.

6. Multiple Sclerosis (MS)
The NIH estimates that up to 350,000 Americans have MS — most of them 20-40 years old. Women are more than twice as likely as men to get this central nervous system disorder.

With MS, the immune system attacks the brain, spinal cord and optic nerves, says Barbara Giesser, M.D., a Los Angeles neurologist and one of the authors of Multiple Sclerosis for Dummies.

It destroys myelin, the protective sheath that covers nerves. That interferes with signals between the brain and the rest of the body and causes the numbness, tremors and pain that are hallmarks of the disease.

But the progression of MS is different in everyone, Dr. Giesser says, and most people with MS have a normal life expectancy. MS isn’t fatal “and it’s not contagious,” she adds.

Because symptoms can be mild, intermittent and overlap other diseases, some patients go years before being diagnosed.

MS can look like everything from lupus to Lyme disease to infections and metabolic and inflammatory diseases, Dr. Giesser says.

“A common symptom is numbness and tingling, but there are a billion things that can cause that.”

Symptoms include:

• Depression
• Numbness or weakness in legs or arms
• Vision problems and eye pain
• Tingling or pain throughout the body
• Tremors
• Balance problems
• Dizziness

How to treat it: MS is treatable, Dr. Giesser says, “but we don’t have a cure for it.”

If a doctor suspects MS, he’ll first do blood tests to rule out other ailments with neurological symptoms, such as Lyme disease.

The next step is a neurologist’s evaluation. Magnetic resonance imaging (MRI) of the brain can show lesions, indicating myelin damage.

Corticosteroids can reduce inflammation and other medications called interferons can slow the disease's progression over time, but may damage the liver.

Physical therapy may help with mobility problems. Integrative medical specialist Andrew Weil, M.D., recommends light aerobic exercise and some natural supplements, such as ginger and turmeric, among others.

Consult your doctor before considering alternative methods.

And most MS patients must avoid exposure to any hot environment, because their symptoms get worse. In fact, before the use of MRIs, the disease often was diagnosed by putting patients in a hot bath.

What’s Your Inflammation IQ?
Research indicates that inflammation is behind more than 80% of the conditions we suffer from – everything from arthritis to heart disease. Fighting it can get you on track to a healthier, happier life. Take this inflammation quiz and find out how much you may already know.

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