Autoimmune Diseases: Signs, Myths, Realities, New Treatments and the AI challenges

In this episode, Dr. Diana Girnita and Dr. Vishnu Devala explore the complexities of autoimmune diseases, discussing their causes, symptoms, and the latest treatments. They delve into the role of gut health, environmental triggers, and the potential of AI in transforming diagnosis and treatment. The conversation also addresses common myths and misconceptions, offering insights into managing these conditions effectively.

Takeaways

• Autoimmune diseases can affect various body systems, not just joints.
• AI has potential but cannot replace rheumatologists.
• Gut health plays a significant role in autoimmune conditions.
• Vaccines do not increase the risk of autoimmune diseases.
• Lifestyle changes can significantly impact autoimmune disease management.
• CAR T cell therapy shows promise for autoimmune treatment.
• Genetic testing for autoimmune diseases is not recommended for everyone.
• Environmental triggers can influence autoimmune disease onset.
• Women are more prone to autoimmune diseases due to biological factors.
• Misinformation about autoimmune diseases is widespread and harmful.

Chapters

• 00:00:00 Introduction to Autoimmune Diseases
• 00:03:00 Role of AI in Medicine
• 00:06:00 Gut Health and Autoimmunity
• 00:09:00 Vaccines and Autoimmune Diseases
• 00:12:00 Lifestyle Changes and Management
• 00:15:00 New Treatments and CAR T Cell Therapy
• 00:18:00 Genetics and Autoimmune Diseases
• 00:21:00 Environmental Triggers
• 00:24:00 Women and Autoimmune Diseases
• 00:27:00 Combating Misinformation

Transcript

Autoimmune diseases seem to be everywhere, not just in the news, but affecting millions of people. Maybe there is someone that you know, or maybe it is you. They are not just about sore joints. They can impact your skin, your gut, and even your brain. As a rheumatologist, I have witnessed firsthand how complicated and confusing autoimmunity is, and I hold a PhD in immunology.

Because there is so much controversy. Are we in the middle of a true pandemic of autoimmune diseases or has modern medicine improved the ability to detect these diseases? Can artificial intelligence truly transform the way that we detect and we treat autoimmune diseases or is it just the latest buzzword? Is it your gut health, chronic stress, or your family?

DNA making you sick? Or are we just jumping to conclusions too fast? Are those new treatments that we read about—the CAR T cell therapy—the breakthrough, the cures, or is just experimental science? Let's dive in. Let's find out what's myth, what's real, and talk about what patients with autoimmune diseases need to know.

Today, I have the pleasure to have a great guest, Dr. Vishnuteju Devalla. He is a leading expert in autoimmune diseases and he's here to give us a better understanding about autoimmune diseases. Dr. Devalla, welcome.

Dr. Vishnuteju Devalla:
 Yeah, thank you for having me. We're going to start with a very easy question, but also very complicated. What are the autoimmune diseases and what are the most common signs and symptoms?

Well, there are quite a few autoimmune diseases out there. If we break down the word autoimmunity, it means it's your own immune system reacting against your own proteins. So there's no foreign agent here. Your immune system just gets tricked and starts to cause or attack your own proteins. The end result of that is inflammation. Further down, you tend to see symptoms like fatigue, joint pain, exhaustion, rash, severe muscle inflammation, muscle aches. There are really no symptoms that an autoimmune disease can't cause. Essentially, they can cause a wide variety of symptoms. So, that's what autoimmune diseases are—diseases of your own immune system that result in systemic symptoms.

In our days, we see autoimmune diseases spelled out everywhere in the news and social media. But are we really seeing an epidemic of autoimmune diseases or are we just better at diagnosing them? I think it's partly both. We are, in many ways, blessed to be alive at this age because our understanding of autoimmune diseases has improved so much over the past even 10 years.

So our awareness has improved a lot, and it's very likely for one person to know at least one or two other people with autoimmune diseases. Our awareness is growing, so we know how to diagnose them and can catch them early. On the other hand, some of these diseases may thrive with the kind of treatments we are using for other illnesses that trigger autoimmune diseases. The science has not yet caught up with how that happens, but I do think there is some increase in new autoimmune diseases.

But the vast majority is just our awareness has gotten a lot better. When we talk about autoimmune diseases, we try to simplify the complexity, but are we talking about one autoimmune disease or people having a complex of autoimmune diseases? If you have one autoimmune disease, you’re more likely to develop another.

It's not unusual to see one person with multiple autoimmune diseases. They may not all impact the same system or be treated by the same specialist. For example, Hashimoto's thyroiditis is common and is an autoimmune thyroiditis. When we look at our patients with lupus, rheumatoid arthritis, or other connective tissue diseases, many also develop thyroid disease. It's common to have more than one autoimmune disease. From our understanding so far, it comes from inheriting chains of genes.

So, it's not unusual to have more than one. Many patients struggle to find answers, often going from doctor to doctor until someone thinks their problems are related to an autoimmune disease. Why does it take so long for our patients to find help?

Autoimmune diseases are hard to put together. In rheumatology, that's all we deal with, so we see the world differently. Many times, patients have seen four or five doctors before ending up in our office. I joke that no one else knows what's going on, but that's what rheumatology is for. These conditions are syndromically different from most other medical illnesses and the patterns are harder to recognize.

So, it's difficult for clinicians, especially those not exposed to it daily. It really comes down to pattern recognition and symptoms that are hard to piece together. Most of the time, our patients do not respect the textbook.

Their symptoms, as you probably have seen, do not follow the textbooks. Absolutely. There are many myths and misconceptions about autoimmune diseases, and some are disturbing. What are the myths you wish would disappear?

The most common myth I come across is about lab testing. People put a lot of weight on lab tests, and there’s a lot of misinformation. We do rely on blood work, but it's not the sole driver of diagnosis. It’s only one variable, not the primary one. Patients often come in saying their tests were normal or they had positive tests and want to know what can be done. I educate them that testing is supportive, but not the main component. The whole picture matters. The patient plays the biggest role.

Testing supports what’s really going on with the patient. I’d encourage patients not to put too much weight on tests as it creates unnecessary anxiety.

Another myth is that autoimmune diseases are uncommon, when in fact they’re very common. Ten percent of the world’s population has some form of autoimmune disease—that's one in ten people.

People may have not only one, but two or more autoimmune diseases. Which diseases usually associate? The genes we inherit often code for inflammatory conditions, sometimes for specific cell lines like T cells or B cells. With that, you inherit a pattern. Autoimmune diseases can impact the joints, skin, blood cells, muscles, and more. There’s really no part of your body that can't be affected.

In my experience, I've seen people with Sjögren’s and associated thyroid disease, autoimmune thyroid diabetes, lupus, rheumatoid arthritis, psoriasis, and inflammatory bowel diseases like Crohn’s or ulcerative colitis. I always ask patients about these associations. Fatigue, for example, often leads me to investigate further. It all depends on the types of genes affected.

Some people worry that medications or vaccines could trigger autoimmune diseases. What is the reality? Let's start with vaccines. Vaccines do not increase the risk of autoimmune diseases. There are environmental triggers for autoimmune diseases, and it's hard to figure out exactly which trigger it was. There are rare reports of conditions like Guillain-Barré after the flu vaccine, but it’s extremely rare. For 99% of people, vaccines are not a worry. They save millions of lives every year.

So, I disagree with the notion that vaccines increase the risk. There will always be a small subpopulation affected negatively, in any large group, but the importance is that negative impact is such a small percentage. Similarly, a few medications may cause inflammatory conditions, but for most people, this isn’t a concern. Medication can be life-saving and life-giving.

Most of the time, it’s environmental factors or genetic predisposition that play a big role.

Because we talk about genetics and companies that test for different genes linked to autoimmune diseases, should everyone be screened genetically? The short answer is no.

A lot of us carry genes that code for autoimmune diseases, but not everyone develops the disease. We don't know what really flips that switch. You could have the genes your whole life and never know it. So, if you're healthy with no symptoms, genetic testing will likely just cause unnecessary anxiety. If you do have multiple autoimmune diseases and you’re curious, it’s something to consider, but even then, it won’t change treatment outcomes.

Let’s talk about toxins and environmental triggers like microplastics and viruses. What role do they play in autoimmune disease onset? Viruses can activate or turn off genes, and they’re used in gene therapy. We've known viral triggers for ages. Now, we're learning about environmental triggers like silica, cigarette smoke, and toxins. Microplastics cause many issues in the gut and lungs but currently, there’s no direct link to autoimmune diseases. Many allergens and antigens can trigger autoimmune diseases, but there are too many to avoid completely. We're learning more about how our immune system reacts to environmental triggers.

We also see that autoimmune diseases affect women disproportionately. Why is this? Is it biology or hormones? Both. The X chromosome encodes for many immune genes, and women have two X chromosomes. Sometimes, genes on the “silenced” X chromosome still get activated, so women are likely to have more active immune genes, which may predispose them. Estrogen promotes B cell growth (which produce antibodies), and women have a stronger immune system to help pass on immunity to children. This may also mean a more reactive immune system and increased risk of autoimmunity.

Let’s transition to gut health—the microbiome’s role in autoimmune disease. There’s a lot of hype about changing your gut to prevent or cure autoimmunity. What do we know? Our gut plays a huge role in immunity—60-70% of your immunity is in the gut. Gut health directly correlates with systemic inflammation. A healthier gut can improve inflammatory conditions. A diverse microbiome has a positive effect. Gut health is only part of a multifactorial approach, not the whole solution.

Leaky gut—is it real or just a buzzword? It’s mainly a buzzword, but increased gut permeability does play a role in inflammation. It’s better to have a strong barrier between the gut and the immune system. Gut permeability can be measured and is linked to increased inflammation, but it’s not clear how bad it is or whether it directly triggers autoimmune disease.

Lifestyle and diet, stress, sleep—their impact on autoimmune diseases? Healthy lifestyle is hugely important, but not a cure. Eating well, sleeping well, managing stress, exercising, and maintaining mental health all make a big difference. Lupus studies show poor diet, smoking, and stress worsen flares.

When choosing drugs, why do we start with some, like oral medications, and not others (e.g., biologics)? My approach is whatever works best. There are injectables, infusions, and oral medications; tablets aren’t necessarily worse or better than injections. The pattern of inflammation varies between people, so responses differ. Oral tablets are easily accessible and well-studied, so we start there. If they don’t work, we try other drugs. It’s hard to predict what will work, so we try various options.

Side effects from biologics—how common are serious ones? Any medication can harm a minority of patients, but it's extremely rare for patients to get fatally sick. The benefits far outweigh risks. The internet often amplifies negatives, but most patients benefit greatly. Only a handful experience severe side effects. There’s some bias—positive experiences are rarely shared online.

We should give credit to these medications. With new treatments like CAR T cell therapy, what is its promise for autoimmune diseases? There’s a lot of promise. CAR T cells have been used in cancer; these immune cells are supercharged to destroy other immune cells causing inflammation. They are being explored for lupus, scleroderma, and interstitial lung disease. While not a cure yet—we'd need to silence the underlying gene—treatment options are rapidly evolving.

Stem cell therapy and transplants could also transform outcomes for diseases like scleroderma. Online, there are people claiming to cure autoimmune diseases. Can they really be cured? “Cure” is a strong word. If it means the disease vanishes forever, that’s not realistic. We help manage disease to the point it's not a burden, but don’t truly eliminate it.

Looking to the future, let's talk about AI in medicine. Some say AI can replace doctors—can it replace rheumatologists? No, AI can't replace physicians. AI can help us see more patients and be efficient, but cannot physically examine, recognize patterns, or provide context.

Most patients wait months to see a rheumatologist, often using AI chatbots to check symptoms. Are these reliable? Not really. AI lacks context and can cause anxiety. Symptoms may suggest lupus but are not specific. Physical exam and history are crucial; AI can't provide diagnosis or treatment. It's understandable that patients seek answers, but AI can create anxiety.

Seek expert care and don't rely solely on online resources. Instead of traditional referral paths, seek online medical consultations for quick, valuable answers from specialists. Many patients come convinced they have a disease because AI suggested so, but AI can’t provide context or prescribe treatment—always consult a doctor.

There is a lot of misinformation about autoimmune diseases and treatments on social media. How do we fight it? Misinformation leads people the wrong way and can cause harm. Seek expert care—it’s the safest path.

Find an expert to discuss your concerns and start there. Wrong answers from misinformation increase stress and worsen health. Seek expert care before using online resources.

Thank you for this honest discussion and for partnering with Rheumatologist On Call. Your balanced approach bridges traditional and holistic medicine, which is critical for patients with autoimmune diseases. Please share some words of encouragement for people seeking answers or newly diagnosed.

Dr. Vishnuteju Devalla:
 I encourage patients to advocate for themselves and don’t be afraid to leave the traditional health environment if it’s not working for you. Burnout is high, and patient satisfaction is low. Take a leap of faith—better answers and care may come from outside the traditional system. Don’t give up. If you’re hurting and feeling like the system isn’t working, reach out—people are available and waiting to help.

Thank you, Dr. Devalla.