The Immune System & Rheumatic Disease


Our immune system can mistakenly target normal tissue in our own body rather than foreign intruders such as viruses or bacteria causing damage and resulting in an autoimmune disease.

Genes and environmental factors, such as smoking, can increase the risk for developing an autoimmune illness.

A rheumatologist is specifically trained to diagnose and treat autoimmune disease.

Biologic and other immunosuppressive medications specifically target parts of the immune system to stop/turn off the inflammation that is causing damage.

What Is the Immune System?

The immune system is complex and allows us to identify and destroy foreign invaders (bacteria, viruses, fungi, etc.) and monitor our own cells to prevent them from growing uncontrollably as in tumors or cancers.

There are times, however, when the immune system gets confused. It can no longer distinguish your own good tissue from harmful foreign invaders. It mistakenly directs inflammation against your own tissue causing inflammation in your joints, muscles, blood vessels, kidneys, and virtually any tissue in your body resulting in autoimmune (self- immune) diseases. They include, among others, rheumatoid arthritis, systemic lupus, scleroderma, and vasculitis.

What Causes Autoimmune Disease?

What causes autoimmune diseases is not entirely clear. First, certain viruses and smoking are thought to be involved in activating the immune system and contributing to the development of autoimmune diseases. Second, a person's genetic makeup increases their risk of developing autoimmune disease. For example, people with a gene called HLA-DR4 have an increased risk of developing rheumatoid arthritis. On the other hand, we have learned through much research that genetics are only part of the story. It typically takes both the genetic makeup and environmental exposures together to develop an autoimmune (self-immune) state.

How Are Autoimmune Diseases Diagnosed?

Autoimmune diseases can be very difficult to diagnose. Each diagnosis requires a thorough history and physical exam, and often many laboratory tests. Sometimes, imaging and biopsies are also ordered in the workup by a rheumatologist.

How Are Autoimmune Diseases Treated?

Therapies target our own immune system and can help treat diseases.

Drugs used may include medications that fight inflammation very quickly (i.e., steroids or prednisone), oral medications that change the course of the disease over time (i.e. methotrexate), or even newer biologic medications which target specific molecules of the immune system responsible for inflammation (e.g. TNF inhibitors, IL-6 inhibitors, etc).

These drugs suppress the immune system, so careful monitoring of side effects by your rheumatologist is essential.

Updated April 2023 by Kristen Lee, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

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