Autoimmune Disease: Treatments and Outcomes

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.^9-11 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.¹² 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 The combined direct and indirect costs from 2008 through 2014 have been estimated at $46 billion annually.¹³

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.^14-16

• 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.¹⁷ A 2018 systematic review identified beneficial effects from following a Mediterranean diet in reducing pain and increasing physical function for those patients with RA.¹⁸
• 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.¹⁹

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.²⁰ 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.²⁰

Mindfulness meditation, a cognitive practice premised on sustaining nonjudgmental awareness of arising sensory events, also reliably attenuates pain in autoimmune patients.²¹ Mounting evidence also supports the effectiveness of acupuncture to treat chronic pain conditions, including some autoimmune conditions.²² 

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. At IFM’s upcoming Immune Advanced Practice Module (APM), learn more from functional medicine experts about autoimmune disorders and the clinical applications and lifestyle-based tools that help support immunity and health outcomes.