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Autoimmune Disease: Treatments and Outcomes

Improve Quality of Life for Autoimmune Patients

Autoimmune diseases have increased dramatically worldwide since 1939,1 encompassing more than 80 disorders.2 Rheumatoid arthritis (RA), type 1 diabetes, psoriasis, and inflammatory bowel disease (IBD) are among the more common.

Collectively, autoimmune disorders are one of the most prevalent diseases in the US and affect up to 10% of the US population, or an estimated 24 million people.3,4

Recent reporting found that while autoimmune diseases are more prevalent among females, they may also disproportionately impact specific racial groups, but sparse data exists on minority group rates in the US.5 To compound the potential prevalence of autoimmunity, studies indicate that over eight million additional people have autoantibodies that may indicate future development of an autoimmune disease.4,6

While the direct economic cost of autoimmune diseases in the US is difficult to determine, the National Institute of Allergy and Infectious Diseases has estimated that the annual cost to the healthcare system is more than $100 billion, not including the cost of uninsured individuals, which is estimated to be at least another $25 billion per year, according to the American Autoimmune Related Diseases Association.7

Medications and Biologic Drugs

Medications and biologic drugs are used in the management of autoimmune diseases attempting to control disease flares, limit inflammatory damage, and extend periods of remission.8,9 However, consistent results may not be seen in each patient, there may be potentially serious side effects, and higher financial costs have also been noted.9,10 The goal of contemporary treatment for RA, for example, is to halt or slow the progression of the disease before joint damage occurs.10 Treatment with disease-modifying antirheumatic drugs (DMARDs) and biologic DMARDs in the early stages of RA has made joint destruction less common, but not all patients respond to DMARDs—either the conventional or biologic variety.7

A 2012 report showed that the effectiveness of approved therapeutics in a broad group of autoimmune diseases was no more than 50%.7 Effectiveness was expected to be even lower in the case of biologic therapies, which do not achieve remission in greater than 20-30% of patients.7 Echoing this potential outcome, a 2017 report on anti-TNF biologics reported that up to 40% of patients have no response to anti-TNF treatment.9 Although biologics have proven to be an effective treatment for some patients with RA or other diseases, like psoriasis, they are recommended only for patients with insufficient response or intolerance to DMARDs because of their cost.10

Rheumatoid Arthritis – a focus

Some prescription treatments for RA can lead to devastating long-term side effects; for example, DMARDs have been significantly associated with dementia in RA patients.11 Compared with the general population, patients with RA have twice the mortality rate, with median life expectancy reduced by seven and three years in men and women, respectively.7 Other comorbidities of the disease include osteoporosis, infection, subcutaneous nodules, Sjögren’s syndrome, lung disorders, and lymphoma.7

If left untreated or poorly controlled, RA limits the ability of patients to function well in vocational or domestic settings.7 Research has shown that up to half of such patients leave the workforce less than 10 years after disease onset; up to 90% stopped working prior to age 65. The total cost of RA in the US in 2005 was estimated at $39 billion. About half of the total was attributed to intangible costs—with $10 billion attributed to diminished quality of life and $10 billion to premature mortality.7

In light of these staggering statistics, are there any cost-effective treatment options that improve quality of life for autoimmune disease patients?

Modifiable Lifestyle Factors: Nutrition, Exercise, and Meditation

Dietary patterns that promote the consumption of anti-inflammatory foods may help alleviate symptoms of many chronic conditions associated with increased inflammation.12-14

  • As an adjunctive treatment, patients living with RA may turn to dietary interventions such as the Mediterranean diet to reduce systemic inflammation associated with their disease. A 2018 systematic review identified beneficial effects from following a Mediterranean diet in reducing pain and increasing physical function for those patients with RA.15
  • For patients with systemic lupus erythematosus, the anti-inflammatory and immunomodulatory benefit of green tea may have beneficial effects on disease activity and quality of life. A 12-week randomized controlled trial on 68 subjects with lupus found that compared to controls, green tea supplementation (1,000 mg of green tea extract, two capsules/day) reduced disease activity and significantly increased both vitality and general health.16

Physical activity is proven safe and beneficial in most autoimmune diseases; physically active RA patients were found to have a milder disease course, better cardiovascular disease profile, and improved joint mobility.17 Exercise decreases fatigue while enhancing mood, cognitive abilities, and mobility in patients with multiple sclerosis. Physically active patients with type 1 diabetes mellitus have a decreased risk of autonomic neuropathy and cardiovascular disease. Systemic sclerosis patients report decreased disease severity and pain as well as better quality of life with more physical activity.17

Mindfulness meditation, a cognitive practice premised on sustaining nonjudgmental awareness of arising sensory events, also reliably attenuates pain in autoimmune patients.18 Mounting evidence also supports the effectiveness of acupuncture to treat chronic pain conditions, including some autoimmune conditions.19

Conclusion

While prescription medications remain at the forefront in the battle against autoimmune disease, researchers are identifying other treatment modalities to help improve patients’ quality of life. Functional Medicine offers an alternative to symptom suppression—by addressing the underlying mechanisms that cause autoimmunity, we can prevent, and in some cases reverse, autoimmune diseases. To further Functional Medicine practitioners’ knowledge and expertise on autoimmune conditions, IFM, in partnership with the Cleveland Clinic Center for Functional Medicine, offers a first-of-its-kind eBook, Autoimmunity: A Functional Medicine Guide. This guide includes a range of toolkit items and details a comprehensive Functional Medicine approach for the evaluation and treatment of patients with autoimmune conditions.

Learn more about Autoimmunity: A Functional Medicine Guide and how its tools and information may help to improve patient outcomes.

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References

  1. Campbell AW. Autoimmunity and the gut. Autoimmune Dis. 2014;2014:152428. doi:10.1155/2014/152428
  2. Autoimmune diseases. National Institute of Allergy and Infectious Diseases. Last reviewed May 2, 2017. Accessed June 4, 2020. https://www.niaid.nih.gov/diseases-conditions/autoimmune-diseases
  3. Hood E. Measuring autoimmunity in America. Environmental Factor. Published April 2018. Accessed June 4, 2020. https://factor.niehs.nih.gov/2018/4/science-highlights/autoimmunity/index.htm
  4. Autoimmune diseases. National Institute of Environmental Health Sciences. Last Reviewed May 6, 2020. Accessed June 4, 2020. https://www.niehs.nih.gov/health/topics/conditions/autoimmune/index.cfm – footnote1
  5. Roberts MH, Erdei E. Comparative United States autoimmune disease rates for 2010-2016 by sex, geographic region, and race. Autoimmun Rev. 2020;19(1):102423. doi:10.1016/j.autrev.2019.102423
  6. Dinse GE, Parks CG, Weinberg CR, et al. Increasing prevalence of antinuclear antibodies in the United States. Arthritis Rheumatol. 2020;72(6):1026-1035. doi:10.1002/art.41214
  7. Blumberg RS, Dittel B, Hafler D, von Herrath M, Nestle FO. Unraveling the autoimmune translational research process layer by layer. Nat Med. 2012;18(1):35-41. doi:10.1038/nm.2632
  8. McCain J. The disease burden of the most common autoimmune diseases. Manag Care. 2016;25(7):28-32.
  9. Li P, Zheng Y, Chen X. Drugs for autoimmune inflammatory diseases: from small molecule compounds to anti-TNF biologics. Front Pharmacol. 2017;8:460. doi:10.3389/fphar.2017.00460
  10. Joensuu J, Huoponen S, Aaltonen KJ, Konttinen YT, Nordström D, Blom M. The cost-effectiveness of biologics for the treatment of rheumatoid arthritis: a systematic review. PLoS One. 2015;10(3):e0119683. doi:10.1371/journal.pone.0119683
  11. Chou MH, Wang JY, Lin CL, Chung WS. DMARD use is associated with a higher risk of dementia in patients with rheumatoid arthritis: a propensity score-matched case-control study. Toxicol Appl Pharmacol. 2017;334:217-222. doi:10.1016/j.taap.2017.09.014
  12. Ricker MA, Haas WC. Anti-inflammatory diet in clinical practice: a review. Nutr Clin Pract. 2017;32(3):318-325. doi:10.1177/0884533617700353
  13. Sköldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis. 2003;62(3):208-214. doi:10.1136/ard.62.3.208
  14. How to use food to help your body fight inflammation. Mayo Clinic. Published August 13, 2019. Accessed June 5, 2020. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/how-to-use-food-to-help-your-body-fight-inflammation/art-20457586
  15. Forsyth C, Kouvari M, D’Cunha NM, et al. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatol Int. 2018;38(5):737?747. doi:10.1007/s00296-017-3912-1
  16. Shamekhi Z, Amani R, Habibagahi Z, Namjoyan F, Ghadiri A, Saki Malehi A. A randomized, double-blind, placebo-controlled clinical trial examining the effects of green tea extract on systemic lupus erythematosus disease activity and quality of life. Phytother Res. 2017;31(7):1063-1071. doi:10.1002/ptr.5827
  17. Sharif K, Watad A, Bragazzi NL, Lichtbroun M, Amital H, Shoenfeld Y. Physical activity and autoimmune diseases: get moving and manage the disease. Autoimmun Rev. 2018;17(1):53-72. doi:10.1016/j.autrev.2017.11.010
  18. Zeidan F, Alder-Neal AL, Wells RE, et al. Mindfulness-meditation-based pain relief is not mediated by endogenous opioids. J Neurosci. 2016;36(11):3391-3397. doi:10.1523/JNEUROSCI.4328-15.2016
  19. Yin C, Buchheit TE, Park JJ. Acupuncture for chronic pain: an update and critical overview. Curr Opin Anaesthesiol. 2017;30(5):583-592. doi:10.1097/ACO.0000000000000501

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