Global Health Asia-Pacific May 2022 May 2022 - Page 50

Autoimmune Disease
men , she added .
“ Lupus is so complicated that immunologists are still trying to figure out the causation , which includes genetic predisposition and early childhood exposure to common infections like Epstein-Barr virus , mercury , and pesticides ,” she said . “ But when I have a patient in front of me , I won ’ t be able to tell her exactly what mix of things caused her lupus .”
Despite the uncertainties surrounding the causes of these autoimmune diseases , experts do know that a specific pathogen is linked to RA . Porphyromonas gingivalis , one fo the main bacteria responsible for gum disease , can lead to earlier and more severe RA by causing the production of autoantibodies , which can target the body ’ s tissues and are implicated in autoimmune diseases . “ Having good dental hygiene and avoid smoking are two of the main things I can tell my patients , especially those with risk factors for rheumatoid arthritis , to prevent the condition ,” said Dr Ma .
Stress might also be an important component , or at least a trigger , of autoimmune diseases .
One study published in JAMA in 2018 surveyed more than a million Swedish individuals , some of whom had stress-related disorders , and it uncovered an association between stressful events and subsequent development of autoimmune diseases . But while enlightening , the results are a far cry from showing causation .
“ Stress is a well known trigger of autoimmune
Pregnancy : a short-lasting respite or a risk For all their similarities , RA and lupus differ in one important aspect — how they react to pregnancy .
“ When a woman with rheumatoid arthritis gets pregnant , the immune system calms down to protect the foetus ,” which would otherwise be identified as a foreign invader and attacked by immune cells , explained Dr Ma , who added that in general pregnant women could enjoy some respite since their RA disease activity also calmed down . But after the baby is born , usually around six weeks after birth , the immune system fired up again , leading to flares .
By contrast , lupus increases the rates of miscarriage and preterm births while worsening kidney disease in pregnant women , but these challenges can be managed with appropriate treatment , according to Dr Petri . “ Most women with lupus can have a successful pregnancy , but they ’ ll need much more medical care , both from obstetricians , rheumatologists , and perhaps nephrologists , than any other pregnant woman would .” disease , explained Dr Ma , adding that it could also cause flares in patients with the conditions , including RA .
This limited knowledge of autoimmune diseases in the medical community is , to some extent , reflected in the general public who are often oblivious to the complexities of the conditions and the challenges of living with them .
“ There are lots of misconceptions about rheumatoid arthritis ,” said Chan , noting that the condition is often mistaken for osteoarthritis , the most common form of arthritis worldwide that involves the wear and tear of the joints over time and usually develops in old age . She added that many people , especially in the workplace , couldn ’ t grasp the intensity of pain sometimes associated with RA , perhaps because her common experience was really what many would describe as mild or medium-intensity pain . But there were times when she experienced a flare up so painful that she had to ask a colleague to sign a document for her because she was unable to hold a pen .
There ’ s a similar poor understanding of lupus , according to a 2018 World Lupus Federation global survey . It found that , while the condition was a global health problem afflicting people across countries , races , ethnicities , and genders , a slight majority of respondents weren ’ t aware it was even a disease . And among those over 55 who knew about lupus , almost half weren ’ t aware of any complications associated with it . The survey also suggested there was a social stigma attached to the disease as some people mistakenly thought it was contagious and therefore weren ’ t comfortable sharing food with or hugging patients with lupus .
“ There is a clear need to increase understanding of lupus to prevent misconceptions , tackle the stigma and help to encourage social integration for those living with the disease ,” said Jeanette Anderson , Chair of Lupus Europe , one of the founding members of the World Lupus Federation , in a statement .
Treatments work well for some but not all While RA and lupus can wax and wane , they still have no cures . But a combination of drugs , exercise , and other approaches can help manage symptoms .
Drugs include both anti-inflammatories that can relieve pain by reducing the inflammation that damages healthy tissues and immunosuppressants that slow the activity of the immune system .
“ We are fortunate to have lots of treatment options available to treat RA , however , we aren ’ t able to predict which treatment would be the best for a particular patient ,” said Dr Ma . Methotrexate is the most commonly used medication for RA and is well tolerated by most patients while those who can ’ t take it can still benefit from other options like biologic therapy , which can target particular chemicals or proteins responsible for causing inflammation .
This is what happened to Chan , who had to ditch methotrexate because of its unbearable side effects , especially severe nausea . Her condition only got better when she received tofacitinib , a drug that targets specific inflammation molecules , unlike methotrexate which has an all-encompassing impact
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