Autoimmune diseases


The Disease that cries Wolf

by Monika Guttman

Lupus-In which the bodies immune system attacks it's own cells-mimics many other illnesses, thwarting diagnosis. But once identified, new drugs and technologies have greatly improved the prognosis

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Until fairly recently, however, autoimmune diseases have been a sort of castaway category in the medical landscape. Diagnosis is often difficult, because symptoms can go into remission for no apparent reason or may mimic some other kind of illness. There are few definitive tests for most autoimmune diseases. Some have even been on the receiving end of media and medical skepticism-chronic fatigue syndrome, now considered an autoimmune disease, was once briefly termed the "yuppie flu" because it was typically seen in young, middle-class women. Research also suffered from the fact that autoimmune diseases affect comparatively limited populations-only two to three million suffer rheumatoid arthritis, for example, nowhere near the 23 million who endure migraines or the 16 million with adult-onset diabetes.

Today the situation is a little different: not only are new drugs helping manage the symptoms, but thanks to progress in both genetic research and molecular biology, scientists are getting a better handle on the immune system in general and, consequently, on autoimmune diseases. Their goal: to determine what causes autoimmune diseases in the first place. That, goes the scientific logic, could lead to a cure.

They face a complicated task, since scientists are still trying to figure out the complicated choreography of the immune system itself.

Commissioned as a defending force, the immune system protects the host body from invasions by foreigners like bacteria, viruses, fungi or parasites. First, there are the scouts-helper T-cells that cruise the blood looking for foreign "antigens"-proteins or carbohydrates that they do not recognize. If they see a foreign antigen, the scouts send in the troops-B cells (which have antibody molecules on their surface) and lymphocytes (hormones). The result is troops attacking the foreign cells with intent to kill, which usually produces inflammation. Then the mediators, called suppressor T-cells, get everybody to calm down by telling the immune system to stop once the invader has been conquered.

What remains a mystery, however, is how all these cells communicate. In the case of autoimmune disease, scientists are investigating if there is a failure to communicate at the scout level, the troop level or the mediator level-or maybe at all three levels simultaneously.

As if this system is not complicated enough, the body also produces lymphocytes that can react against its own cells. At birth, says Horwitz, "The thymus removes a lot of autoreactive cells, but basically everyone is left with enough autoreactive cells to have the potential to develop rheumatoid arthritis, lupus, multiple sclerosis, myasthenia gravis or any other autoimmune disease. The immune cells are there with the potential to turn on these diseases."

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