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When something normal becomes bad

By on December 24, 2018 in Columnist with 0 Comments

Jim BrownBy Jim Brown, M.D.

Almost everyone has had experience with inflammation of one sort or another in his or her lifetime.

Whenever we cut ourselves, are stung by an insect, suffer any injury like a broken bone, sprain an ankle, have surgery or an infection, we become aware of inflammation with its redness, tenderness, swelling and pain that comes on rapidly and is generally short lived.

Inflammation is a major defense mechanism of our body that fortunately we are born with.

When something harmful or irritating affects a part of our body, there is a biological response from our immune system to try to remove it.

When this happens our damaged cells leak and release chemicals that cause the blood vessels to leak, causing swelling. These chemicals also attract white blood cells that “eat” germs and the dead or damaged cells.

Infections, wounds, and any damaged tissue would not heal without this response to acute injury.

On the other hand, many people suffer from chronic inflammation that plays a critical role in some of the most challenging diseases of our time. These disorders are called autoimmune diseases, which are conditions caused by our own immune system.

In these cases, one’s immune system produces antibodies that instead of fighting infection and defending against other invaders instead it attacks one’s own normal tissues.

The actual cause of autoimmune disease is unknown, but environmental influences, infections and exposure to certain chemicals possibly might be involved. Autoimmune diseases seem to run in families suggesting genetic factors.

It is unknown what causes the immune system to “misfire” like this. At other times, low-level inflammation becomes activated when there is no apparent injury or disease.

Unfortunately, autoimmune disorders are relatively common and are increasing in incidence worldwide. In 2016, NIH (National Institutes of Health) estimated that 24 million Americans suffer from autoimmune diseases. Another source suggests that as many as 50 million Americans suffer from autoimmune diseases.

Women get autoimmune disease at a rate of 2:1 vs. males or 6.4 percent of females vs. 2.7 percent of males. In females it often starts during a woman’s childbearing years.

There are 80 to 100 different autoimmune disorders. Some of the more common and familiar ones are rheumatoid arthritis, psoriasis and psoriatic arthritis, multiple sclerosis, systemic lupus erythematosus (Lupus) and inflammatory bowel diseases, including Crohns disease and ulcerative colitis, Sjogren’s syndrome, vasculitis (inflammation of blood vessels ) and Hashimoto Thyroiditis.

The symptoms are fairly non-specific and may include chronic fatigue, mouth sores, chest pain, cramping abdominal pain, low grade fevers, rash, muscle and/or joint pain, tingling of the hands or feet and weight loss.

The diagnosis initially made by your physician is suggested by your history and by a physical exam. There is no single test that makes the diagnosis. However, most autoimmune disorders frequently show a positive antinuclear antibody blood test (ANA) that suggests the likelihood of an autoimmune disorder.

Gastrointestinal diseases like Crohns disease and ulcerative colitis are generally confirmed by endoscopy and biopsy when the disease is suspected.

Treatment generally is directed at reducing the over-active immune response and reducing inflammation. Non-steroidal anti-inflammatory drugs, corticosteroids and immune suppressing drugs are currently the mainstays of treatment. Many of these are currently heavily marketed in television commercials. Your doctor will decide the best drug and treatment regimen for you.

The goal of immunosuppressant therapy is to find an effective treatment plan having the fewest, and least harmful side effects. Immunosuppressant drugs are available only by a prescription from your doctor. These medications come as tablets, capsules, liquids, and injections. A combination of drugs may be used.

Newer treatments for autoimmune disease, aimed at reducing the immune response, are rapidly advancing and changing. These medications are best prescribed by specialists dealing with autoimmune disorders.

Jim Brown, M.D., is a retired gastroenterologist who has practiced for 38 years in the Wenatchee area. He is a former CEO of the Wenatchee Valley Medical Center.

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