Presentation
Symptoms depend on type of reaction due to autoimmunity and its site. The common symptoms are fatigue, fever, malaise, joint pain, and rash. Anaphylaxis is characterized by dizziness, rash itching, breathless, tachycardia and lip swelling. Autoimmunity against blood components is characterized by fatigue, yellow urine, and fever. Involvement of lung is characterized by cough, fever and dyspnea [6].
Entire Body System
- Fever
Autoimmunity against blood component is characterized by fatigue, yellow urine, and fever. Involvement of lung is characterized by cough, fever, breathlessness. [symptoma.com]
In each patient, autoimmune disease manifested as severe joint pains, myalgias, fever, rash, and proteinuria. [ncbi.nlm.nih.gov]
Vasculitis — Rash, night sweats, headache, fever, weight loss, weakness or numbness, aches and pains, and fatigue result from this disease that inflames blood vessels. [templehealth.org]
Early symptoms can include: Fatigue Fever Hair loss Rash Pulmonary problems Kidney problems Swollen joints Gastrointestinal problems Thyroid problems Dry mouth and eyes Whole-body symptoms like fatigue, fever, and weight loss are common in SLE. [verywellhealth.com]
- Low Fever
Often, the first symptoms are fatigue, muscle aches and a low fever. The classic sign of an autoimmune disease is inflammation, which can cause redness, heat, pain and swelling. [medlineplus.gov]
Respiratoric
- Hemoptysis
We report a 73-year-old male who presented with cutaneous blistering, upper gastrointestinal bleeding, and hemoptysis. He later developed right flank pain secondary to a retroperitoneal hematoma. [ncbi.nlm.nih.gov]
Gastrointestinal
- Abdominal Bloating
Abdominal bloating and pain Diarrhea or constipation Weight loss or weight gain Fatigue Missed menstrual periods Itchy skin rash Infertility or miscarriages Diabetes type 1 A disease in which your immune system attacks the cells that make insulin, a hormone [womenshealth.gov]
Cardiovascular
- Thrombosis
The primary objective was the efficacy of HCQ in preventing the first thrombosis. The secondary objectives were the thrombosis incidence rate, and the effects of HCQ on aPL profile and mortality rate. [ncbi.nlm.nih.gov]
Deep Vein Thrombosis: Symptoms, Causes, and Treatment Deep vein thrombosis is a condition that occurs when a blood clot develops within a vein that is located deep in the body. [scientificanimations.com]
Deep Vein Thrombosis If you have RA or MS, or another condition that causes you to be sedentary or in need of a wheelchair, you are at risk of developing deep vein thrombosis, in which blood clots form in the legs; in some cases, these clots can travel [verywellhealth.com]
| N Engl J Med 2018; 378:2010-2021 Antiphospholipid antibodies can induce endothelial-cell, complement, platelet, neutrophil, and monocyte activation, leading to thrombosis, renal failure, heart valve disease, pregnancy loss, and neurologic complications [nejm.org]
It is not known why patients of antiphospholipid syndrome often have the tendency to be "catapulted" into a serious or fatal multiorgan failure, while the same triggers in other individuals may only result in recurrent large vessel thrombosis. [rarediseases.org]
Musculoskeletal
- Joint Deformity
Some of the most common symptoms are joint pains, fever, rashes, fatigue, and a general feeling of illness. If the joints are severely affected, it will be likely that the patient will experience joint deformity as well. [docdoc.com.sg]
Rheumatoid arthritis is a type of arthritis in which autoimmunity causes the immune system to attack tissues in the joints, leading to muscle pain, joint deformities, fatigue, weakness, appetite loss, weight loss, and sometimes confinement to bed. [everydayhealth.com]
[…] can eventually result in bone erosion and joint deformity. [kaleidoscopefightinglupus.org]
Rheumatoid arthritis: generally results in the body attacking the joints, causing joint deformation, debilitating pain, and stiffness, 2. [breastfeedingusa.org]
- Muscle Swelling
Autoimmune disease symptoms The early symptoms of various autoimmune diseases are quite similar, such as: Fatigue Ache in muscles Swelling Low-grade fever Redness Skin rashes Numbness and tingling in the hands and feet Loss of hair Trouble in concentrating [scientificanimations.com]
BOTTOM LINE: Symptoms like fatigue, muscle aches, swelling, and redness could be signs of an autoimmune disease. Symptoms might come and go over time. See a doctor if you have symptoms of an autoimmune disease. [healthline.com]
Symptoms that are common to most autoimmune diseases include: Fatigue Achy muscles Swelling and redness Low-grade fever Trouble concentrating Numbness and tingling in the hands and feet Skin rashes Autoimmune diseases follow different courses and manifest [verywellhealth.com]
- Arthralgia
Most developed fever and arthralgias/arthritis. Other findings included serositis manifested by tachycardia, dyspnea and pleural effusions, headaches, and hair loss. [ncbi.nlm.nih.gov]
Patients presenting with DILE may experience fever, arthralgia, arthritis, myalgia, or serositis. [pharmacytimes.com]
- Myalgia
In each patient, autoimmune disease manifested as severe joint pains, myalgias, fever, rash, and proteinuria. [ncbi.nlm.nih.gov]
Patients presenting with DILE may experience fever, arthralgia, arthritis, myalgia, or serositis. [pharmacytimes.com]
Skin
- Alopecia
Development of diffuse BFHs has been associated with autoimmune disease and with the development of diffuse alopecia. Two women with autoimmune diseases had diffuse alopecia develop. [ncbi.nlm.nih.gov]
Types of autoimmune diseases include: Alopecia areata, Antiphospholipid antibody syndrome (aPL), Autoimmune hepatitis, Celiac disease, Diabetes type 1, Graves disease, Guillain-Barre syndrome, Hashimotos disease, Hemolytic anemia, Idiopathic thrombocytopenic [scitechnol.com]
[…] history of autoimmune disease People who have certain environmental exposures that could act as the trigger People of a particular race or ethnicity Many types of arthritis are considered autoimmune diseases, including: Other autoimmune diseases include alopecia [verywellhealth.com]
- Skin Rash
Some of the drugs used to treat these conditions include: Nonsteroidal anti-inflammatory drugs (NSAIDs) Immune-suppressing drugs Some treatments are also available to alleviate symptoms such as pain, inflammation, skin rashes and fatigue. [scientificanimations.com]
rashes.3 Childhood poverty linked to rheumatoid arthritis in adulthood – NIEHS researchers discovered a link between lower socioeconomic status in childhood and rheumatoid arthritis in adulthood. [niehs.nih.gov]
Others include skin rashes, vaginal dryness, joint pain, extended fatigue and swollen glands behind the jaw. [templehealth.org]
The symptoms of lupus may include joint pain, skin rashes, kidney problems, inflammation of the lung and/or heart, anemia, increased clotting (thrombosis), memory problems, and more. [verywellhealth.com]
- Eczema
[…] that resulted in complete remission of his eczema. [ncbi.nlm.nih.gov]
Common Autoimmune Disease Symptoms Some of the most common autoimmune disease symptoms you should look out for include: Headaches Anxiety Brain fog Attention deficit problems Body rashes, red bumps on facial skin and red flaking skin Acne Rosacea Eczema [draxe.com]
Eczema Eczema, also known as atopic dermatitis, is generally a mild skin disease and is the most common skin disease in primary immunodeficiency diseases. [primaryimmune.org]
- Erythema
We describe 2 patients with photodistributed violaceous plaques: one with associated heliotrope rash and malar erythema, and the other with scalp involvement and Gottron-like papules. [ncbi.nlm.nih.gov]
The blistering of mucous membranes is also a common symptom in these conditions: Erythema multiforme Viral skin infection (eg, herpes simplex, herpes zoster, or enteroviral stomatitis) Aphthous ulcers Behçet syndrome [14]. [dermnetnz.org]
MMP3[26] TRLR2, TLR4,[27] ERAP1[28] Eosinophilic fasciitis Accepted Eosinophilic gastroenteritis IgE IL-3, IL-5, GM-CSF, eotaxin Epidermolysis bullosa acquisita COL7A1 Erythema nodosum Erythroblastosis fetalis II ABO, Rh, Kell antibodies mother's immune [hi.wikipedia.org]
"Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review." J Am Acad Dermatol 72(2): 239-245. Chalker, V., T. Stocki, D. Litt, A. Bermingham, J. Watson, D. [lci.rivm.nl]
- Eruptions
Amicrobial pustulosis associated with autoimmune disease (APAD) is a rare clinical condition, characterized by relapsing pustular eruption, affecting mainly the skin folds. [ncbi.nlm.nih.gov]
Often referred to as “the itch that rashes,” eczema typically begins as patches of dry, itchy skin which worsen and erupt into rash as they are scratched. [primaryimmune.org]
Neurologic
- Tingling
Symptoms that are common to most autoimmune diseases include: Fatigue Achy muscles Swelling and redness Low-grade fever Trouble concentrating Numbness and tingling in the hands and feet Skin rashes Autoimmune diseases follow different courses and manifest [verywellhealth.com]
Autoimmune disease symptoms The early symptoms of various autoimmune diseases are quite similar, such as: Fatigue Ache in muscles Swelling Low-grade fever Redness Skin rashes Numbness and tingling in the hands and feet Loss of hair Trouble in concentrating [scientificanimations.com]
More specific signs can point toward something being wrong: numbness and tingling in hands and feet (also common), dry eyes (common), hair loss, shortness of breath, heart palpitations, or repeated miscarriages can also be caused by an autoimmune response [webmd.com]
Weakness or tingling feeling in the legs that might spread to the upper body Paralysis in severe cases Symptoms often progress relatively quickly, over a period of days or weeks, and often occur on both sides of the body. [womenshealth.gov]
- Headache
Vasculitis — Rash, night sweats, headache, fever, weight loss, weakness or numbness, aches and pains, and fatigue result from this disease that inflames blood vessels. [templehealth.org]
Other findings included serositis manifested by tachycardia, dyspnea and pleural effusions, headaches, and hair loss. All had a positive antinuclear antibody (ANA), and the majority had double stranded (ds) DNA antibodies. [ncbi.nlm.nih.gov]
[…] gain If left un-repaired, it can lead to more severe health issues like inflammatory bowel disease, IBS, arthritis, eczema, psoriasis, depression, anxiety, migraine headaches, muscle pain and chronic fatigue. [draxe.com]
Ten individuals experienced general clinical symptoms, which included abdominal pain, diarrhea, and headache. [omicsonline.org]
Astrovirus infections are marked by symptoms such as diarrhea, vomiting, abdominal cramping, headache, fever, and mild dehydration. [contagionlive.com]
- Seizure
[…] resulting from sensitivity to the sun (photosensitivity) Ulcers in the nose or mouth Two or more joints affected by arthritis with swelling, tenderness, or effusion Inflammation of the heart ( pericarditis ) or lungs (pleuritis) Neurological symptoms like seizures [emedicinehealth.com]
[…] of a seizure. [nejm.org]
These epileptic seizures are episodes that differ from short and approximately unnoticeable to long periods of strong shaking. Epilepsy is recognized by a long-term risk of recurrent seizures. [autoimmunediseases.imedpub.com]
Symptoms can range from fatigue and mild rashes to rare, serious side effects, like seizures. Diagnosis can be difficult, because many symptoms tend to come and go and are frequently nonspecific. [childrenshospital.org]
Workup
The diagnosis can be done by physical exam and laboratory investigation. Important laboratory tests are antinuclear antibody tests, autoantibody tests, complete blood cound (CBC), comprehensive metabolic panel, C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR) and urinalysis.
Chest X-ray and pulmonary function test may be required in case of lung involvement. Similarly, bone marrow biopsy or kidney biopsy may be done if required.
Kidney function test and renal function test may be required in advanced cases or the cases taking treatment for long period or for the cases like graft rejection [7].
Treatment
Symptomatic control, control of autoimmune reaction and maintainance of general immunity are the objectives of treatment. Mainstay of treatment is control of immune reaction by immunosuppressant drugs either corticosteroids like prednisone or non-steroids like tacrolimus, cyclophosphamide, sirolimus, mycophenolate or azathioprine. Further treatment depends on type of disease like hormones, hematinincs, blood transfusion or physiotherapy. Anaphylaxis is an emergency and requires prompt emergency services including oxygen, advanced life support measures, drugs like adrenaline [8].
Prognosis
Autoimmune diseases are chronic, characterized by remission and relapse or flare up. But clinical symptoms are well controlled by treatment [5].
Etiology
The reason that body fails to recognize between ‘self’ and ‘non-self ’may be immunologic, genetic or microbial. Mixed etiology may be possible. There is polyclonal activation of B-cells along with generation of self reacting B-Cells. This may be augmented by increased T helper cell activity. Genetic factors include increased expression of Class II HLA antigens on affected tissues. Infection with virus like Epstein–Barr virus (EBV) or bacteria like streptococcus and mycoplasma may trigger immune reaction against host tissue [2].
Epidemiology
In the United States autoimmune conditions are among the leading causes of death among women of young and middle-age. Incidence rates differ according to disease. Less than one case of systemic sclerosis is diagnosed per 100,000 person years whereas more than 20 cases of adult-onset rheumatoid arthritis are diagnosed per 100,000 person-years. Diseases like type I diabetes primarily occur in childhood and adolescence whereas myasthenia gravis or multiple sclerosis occurs in the mid-adult years. Rheumatoid arthritis, primary systemic vasculitis are diagnosed among older adults [3].
Pathophysiology
Once autoantibodies are formed against own tissue there may be one of four actions, i.e. anaphylactic, cytotoxic, immune complex or cell mediated. Anaphylaxis is characterized by releasing histamine locally or generally. Examples are asthma, hay fever and serum sickness. Examples of cytotoxic reaction are autoimmune hemolytic anemia, transfusion reaction, erthrobalstosis foetalis, idiopathic thrombocytopenic purpura (ITP) and myasthenia gravis. Examples of immune complex reaction are farmer’s lung, glomerulonephritis, collagen disease, Goodpasture syndrome and arthritis. Cell mediate reactions are leprosy and graft rejection [4].
Prevention
Since etiology of autoimmunity is immune-genetic prevention of these diseases is not possible. Only conditions precipitated by bacterial or viral infections are preventable by control of these infections [9].
Summary
Autoimmunity is a condition in which immune system of the body fails to recognize between ‘self’ and ‘non-self ’ and reacts by formation of antibodies against own tissues.
The condition maybe limited to one of the organ like in Goodpasture syndrome or may be may involve specific tissues of different organs like in systemic lupus erythematosus. Clinical symptoms depend on the type of tissue involved. Diagnosis is always done by the detection of autoantibodies against specific tissue and histopathology. Immunosuppressant drugs are important treating agent in these conditions [1].
Patient Information
- Definition: Autoimmunity is a condition in which immune system of the body fails to recognize between ‘self’ and ‘non-self ’ and reacts by formation of antibodies against own tissues. This condition may be limited to one of organ like in Goodpasture syndrome or maybe may involve specific tissues of different organs like in systemic lupus erythematosus. Clinical symptoms depend on type of tissue involved. Diagnosis is always done by detection of autoantibodies against specific tissue and histopathology. Immunosuppressant drugs are important treating agents in these conditions. Examples of the diseases are asthma, hay fever, serum sickness autoimmune hemolytic anemia and transfusion reaction, erthroblastosis fetalis, ITP, myasthenia gravis, farmer’s lung, glomerulonephritis, collagen disease, Goodpasture syndrome, arthritis, leprosy and graft rejection. Diseases like type I diabetes primarily occur in childhood and adolescence whereas myasthenia gravis, multiple sclerosis occurs in the mid-adult years. Rheumatoid arthritis and primary systemic vasculitis are diagnosed among older adults.
- Symptoms: Symptoms depend on type of reaction due to autoimmunity and its site. The common symptoms are fatigue, fever, malaise, joint pain, and rash. Anaphylaxis is characterized by dizziness, rash, itching, breathless, increased heart rate, lip swelling. Autoimmunity against blood component is characterized by fatigue, yellow urine, and fever. Involvement of lung is characterized by cough, fever, breathlessness.
- Diagnosis: The diagnosis can be done by physical exam and laboratory investigation including antinuclear antibody tests, autoantibody tests, complete blood count (CBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and urinalysis. Chest X-ray and pulmonary function test may be required in case of lung involvement. Similarly, bone marrow biopsy or kidney biopsy may be done if required. Kidney function test and renal function test may be required in advanced cases or cases taking treatment for long period or for a cases like graft rejection.
- Treatment: Symptomatic control, control of autoimmune reaction and maintainance general immunity are the objectives of treatment. Mainstay of treatment is control of immune reaction by immunosuppressant drugs either corticosteroids like prednisone or non-steroids like tacrolimus, cyclophosphamide, sirolimus, mycophenolate or azathioprine. Further treatment depends on type of disease like hormones, hematinincs, blood transfusion, physiotherapy. Anaphylaxis is an emergency and requires prompt emergency services including oxygen, advanced life support measures, drugs like adrenaline. Since causes of autoimmunity are immune-genetic prevention of these diseases is not possible. Only conditions precipitated by bacterial or viral infections are preventable by control of these infections. Autoimmune diseases are chronic characterized by period of no symptom and flare up. But clinical symptoms are well controlled by treatment [10].
References
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- Drachman DB. How to recognize an antibody-mediated autoimmune disease: Criteria. In: Immunologic Mechanisms in Neurologic and Psychiatric Disease, Waksman BH (Ed), Raven, New York 1990. p.183.
- Hartmann RC, Conley CL. Studies on the initiation of blood coagulation, III. The clotting properties of canine platelet-free plasma. J Clin Invest 1952; 31:685.
- Swanborg RH. Experimental autoimmune encephalomyelitis in rodents as a model for human demyelinating disease. Clin Immunol Immunopathol 1995; 77:4.
- Horak I, Löhler J, Ma A, Smith KA. Interleukin-2 deficient mice: a new model to study autoimmunity and self-tolerance. Immunol Rev 1995; 148:35.
- Mackay IR, Leskovsek NV, Rose NR. Cell damage and autoimmunity: a critical appraisal. J Autoimmun 2008; 30:5.
- Pendergraft WF 3rd, Preston GA, Shah RR, et al. Autoimmunity is triggered by cPR-3(105-201), a protein complementary to human autoantigen proteinase-3. Nat Med 2004; 10:72.
- Lee YH, Rho YH, Choi SJ, et al. The PTPN22 C1858T functional polymorphism and autoimmune diseases--a meta-analysis. Rheumatology (Oxford) 2007; 46:49.
- Emmi L, Romagnani S. Role of Th1 and Th2 cells in autoimmunity. In: The Autoimmune Diseases, Rose NR, Mackay IR (Eds), Academic Press, San Diego 2006. p.83.
- Oppermann M, Fritzsche J, Weber-Schoendorfer C, et al. A(H1N1)v2009: a controlled observational prospective cohort study on vaccine safety in pregnancy. Vaccine 2012; 30:4445.