Scott Webb (Host): There are over a hundred autoimmune diseases, and we won't be able to tackle all of them today. My guest is here to help us to broadly understand autoimmune diseases, address a few of them specifically, and again, broadly take us through the diagnosis and treatment of many autoimmune diseases. I'm joined today by Dr. Muneera Atcha, she's a Rheumatologist with Salinas Valley Health. This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb.

Dr. Atcha, it's nice to have you here today. We're going to talk about autoimmune diseases or disorders. And I hear that word a lot in the news, the media, social media, autoimmune, and I don't exactly know what that means, I think. And so I'm really glad to have your expertise today. So let's start there. Basic questions. What are autoimmune disorders? How many are there? And are there some that are more common than others?

Muneera Atcha, MD: Let's first talk about immune system to understand autoimmune disease. So our immune system is made up of immune cells, which are present in different areas of our body like blood, lymph nodes, skin lining, and or lining of our mouth and stomach, etc. And wherever, you know, we need a defense for our body.

So basically our immune system is defense system which fights against virus, bacteria, toxins, and cancers. So while doing its normal function, these immune cells occasionally make abnormal protein called antibody, which can potentially attack our own body. And when that happens, we call it autoimmune disease. Now there are more than 100 of autoimmune diseases out there. Some of them are rheumatologic and many of them are non rheumatologic. Most common rheumatologic one includes rheumatoid arthritis, lupus, psoriatic arthritis, whereas some of the common non rheumatologic autoimmune disease include autoimmune thyroid disease such as Graves disease for which you will need to see an Endocrinologist or Crohn's disease or autoimmune hepatitis which is when immune system attack your colon or liver then you see Gastroenterologist.

Host: All right, so it's good to set the stage there. I have a little bit better understanding. I'm still with you. That's good, right? I'm sure listeners are as well. So when we think about the causes, Doctor, of autoimmune diseases or disorders, whatever the right way is to put that, is it genetics, family history, behavior, lifestyle? Just broadly speaking, you know, what causes these autoimmune diseases?

Muneera Atcha, MD: We do not know the exact cause of autoimmune disease. However, there are different theories that researchers have suggested such as genetics, certain infections and environmental factors or toxins like tobacco smoking, etc. can be a risk for autoimmune disease. In addition to that, female hormones may have a role in certain autoimmune diseases.

For example, lupus is more common in females during reproductive age and in general, female gender have higher tendency of developing autoimmune disease than male.

Host: Interesting. Yeah. And you mentioned you used the word rheumatoid earlier. And I was thinking about rheumatologic autoimmune diseases and the common symptoms. I know that that's a common one for folks. So what are the symptoms like, would a person begin to suspect that they may have a rheumatologic autoimmune disease?

Muneera Atcha, MD: So, symptoms of autoimmune disease, so even when we narrow it down to rheumatologic autoimmune disease, there are many different types of autoimmune diseases and, rheumatologic autoimmune disease and it can affect different organs. So symptom of autoimmune disease depends on which organ immune system is attacking or which organ is involved or inflamed.

For example, rheumatoid arthritis most commonly affects joints and symptoms would be painful swollen joints with prolonged morning stiffness. Uh, more than an hour usually. There's another rheumatologic autoimmune disease called Sjogren's disease and that primarily affects exocrine glands and that would cause severe dry eyes, severe dry mouth and swollen glands.

It can also cause joint pain and rarely can affect other organs too. So those are, you know, some examples. Uh, some people can have symptoms of excessive fatigue and not feeling well in general, because of high level of inflammation.

Host: Sure. Yeah, that's what I was thinking about rheumatoid arthritis and I suffer from osteoarthritis, so a little bit different than the rheumatoid variety, but yeah, as you say, it's sort of unique to whatever organ is being affected, of course, so, maybe a good time to speak with your provider, of course, if anything just doesn't feel right, listen to your body, speak up, speak out. Then how do you Doctor, diagnose autoimmune disorders? Are there blood tests? Like, what's involved?

Muneera Atcha, MD: Yeah, so diagnosing autoimmune disease, can sometimes be challenging because, it can resemble other non autoimmune diseases such as infection or hormonal problem, for example. So a thorough clinical history, physical exam is very important and then based on high clinical suspicion of autoimmune disease, and supporting immunologic lab work helps make the diagnosis, in most cases. Sometimes we also need x-rays, CT scan or MRI of a joint or internal organ, to make a diagnosis. And, in few cases, we may need a small sample of affected organ, such as kidney or skin sample, which we call biopsy, to examine cells under microscope to confirm diagnosis.

Host: Yeah, so I get a sense there of the challenges in diagnosing, but certainly patient history, and then all these other things, you know, in your tool belt, so to speak. Doctor, what's an ANA test, the anti nuclear antibody test? Like, I can say that out loud, but I don't know what that means. What does that mean?

Muneera Atcha, MD: Good question. So, actually having a positive ANA can create a lot of anxiety for some individuals, because there is a common misconception that if you have a positive ANA, that means you have lupus, which is not entirely true. So, ANA, which stands for, as you said, Anti Nuclear Antibody, is a very common screening test for autoimmune diseases. It is one of the most non specific tests, which means it can be positive in any autoimmune disease. And, there are more than a hundred of them. It can also be frequently positive in individuals who do not have any autoimmune disease. So that's why it has no diagnostic value by itself. Now, the question can be asked, what do we do when someone has a positive ANA?

So, so that depends on symptoms and clinical suspicion, a specialist may need to order a more specific autoimmune disease lab panel for further evaluation.

Host: All right. I'm still with you here. And I know some folks, you know, I know someone who has rheumatoid arthritis and I know someone who has Crohn's disease. So I, as I'm talking, you're talking here today, I'm like, wait, I know a bunch of people with autoimmune diseases or disorders. Some of them are very debilitating. Just wondering, you know, what can folks expect if they've been diagnosed again, as you say, there's more than a hundred, but broadly speaking, are these things generally pretty debilitating? And we're going to get soon here to how you help folks, but just broadly here, how debilitating can they be?

Muneera Atcha, MD: Well, yeah, they can be pretty debilitating, especially if not treated. So in rheumatology clinic, I see autoimmune rheumatologic disorders such as lupus, rheumatoid arthritis, psoriatic arthritis, and vasculitis to name a few. Each of these diseases can affect different organs and how debilitating can be depends on the severity of the disease.

 These are not fatal in most cases, however, they can be debilitating, especially if not treated. For example, rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis are form of inflammatory arthritis, which can cause joint deformities and disability, if not treated in early stages. So, treating in early stages is very important to prevent that. And, when these autoimmune diseases affect vital organs or major organs such as heart, lungs, or kidneys, it can be life threatening.

Host: Right. Yeah, as you say, generally not life threatening, but it can be. So, early diagnosis, early treatment, as with most things in medicine, of course, but especially when we're talking about autoimmune diseases. I hate to invoke, COVID-19, but, it's still out there, of course, as we know, Doctor.

Just wondering if there's any evidence to support, maybe just something kind of out there in the ether anyway, that maybe COVID-19 is associated with an increased risk of autoimmune disorders.

Muneera Atcha, MD: Well, infection with COVID-19 virus can trigger autoimmune disease, just like other infectious illnesses. Especially for folks who are genetically at risk for autoimmune disease.

Host: Okay. So yeah, there's many good reasons to be vaccinated and hopefully not to get COVID-19. But you say there is a connection there between COVID-19 and autoimmune disorders. All right. So now how do you treat autoimmune diseases and is there a cure per se, or maybe a cure for some, but not others? Take us through this.

Muneera Atcha, MD: Yeah, so generally speaking, there is no cure for autoimmune diseases. The reason is that autoimmune disease is not like a germs or a toxin that we can eliminate from our body with a medication. To treat autoimmune disease, we usually need medications to reduce inflammation and suppress immune system from attacking our body.

We have many new medications, which are now available to target only certain areas of immune system to treat a specific disease. The good news is that with appropriate treatment, many autoimmune diseases can go in a stage where it is no longer active or symptomatic.

Host: That's always good to hear. That brings a smile to my face to hear that there are some treatment options, because as you say, some of these can be very debilitating, in some cases, life threatening, and just really probably affect people's quality of life. And that's what I wanted to ask you for people who are experiencing symptoms, going through really bad flare ups, what would be your best advice for you know, how they can make the best of things, if you will.

Muneera Atcha, MD: Well, first of all, symptoms of each autoimmune disease flare up, can be different. So a flare up means that your autoimmune disease is not well controlled with current medication. And, symptoms can vary from painful and swollen joints in inflammatory arthritis to severe headache or vision loss and giant cell arteritis.

So it is most important to have a discussion with your specialist to be aware of symptoms for which you need to contact clinic immediately or even go to emergency department in some cases. Most disease flares can be treated with steroid medications for immediate relief and then adding another medication for long term disease control, so, won't get any more flare ups.

Host: Doctor, this has been really educational, really helpful today. As I prefaced here at the beginning, I'm not entirely sure about autoimmune disorders, diseases. As you said, there's more than 100. Diagnosis can be a little tricky, but it's why we have experts like yourself. So if folks, you know, have any of the symptoms or listening to their body and something just doesn't sound right, obviously speak with their own providers.

Just give you a chance here at the end, final thoughts, takeaways about autoimmune diseases and disorders and how you can help folks.

Muneera Atcha, MD: Some of the rheumatologic autoimmune diseases such as psoriatic arthritis and rheumatoid arthritis, increases risk of heart disease. So healthy lifestyle is very important to reduce cardiovascular risk with healthy diet, exercise, adequate sleep, and if you have chronic illnesses which increase risk of heart disease like high cholesterol, obesity, high blood pressure, and diabetes, you should follow up with your primary care physician, for tight control of these to reduce risk of heart disease. Second is, early detection of autoimmune rheumatologic disease and treatment is very important to prevent irreparable damage to joints and organs. It is also important to get labs done and follow up with your specialist as recommended on a timely manner for close monitoring of disease activity and to monitor medication side effects to prevent flare ups.

 Lastly, following up with primary care physicians for age appropriate vaccinations and cancer screening is also important, because some of the autoimmune diseases and medications, can be associated with increased risk of cancer and infection.

Host: Yeah, that all sounds good. You know, some of the responsibility of course is on us to speak with our providers, schedule those appointments, get those tests done, all of that. And we have a better understanding certainly today of what autoimmune diseases are, how they affect people, how you can help folks, what we need to do to help ourselves. So thank you so much.

Muneera Atcha, MD: Thank you for having me.

Host: Dr. Atcha sees patients at Salinas Valley Health Rheumatology. To schedule an appointment, please call 831-424-1400.

And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.