Autoimmune diseases, part 3

By Alan Koenigsberg, M.D.

This week, I’ll dive into three more autoimmune diseases, which may not be as well-known but are fairly common from a medical perspective: systemic lupus erythematosus (SLE), multiple sclerosis (MS) and rheumatoid arthritis (RA).

SLE derives its name from the skin rash that many people have, which is known as a “butterfly rash” (which often resembles the face of a wolf, hence the Latin term “lupus”). This condition affects the membranes of any organ of the body, so its symptoms depend on the organ system. It tends to affect women more than men and can often cause facial skin rashes, which can be uncomfortable and indeed painful.

Other common signs and symptoms may be fever, fatigue, pain and swelling of joints, shortness of breath, chest pain, dry eyes and sun sensitivity.

There seems to be a genetically inherited tendency to this condition and some form of trigger usually brings on the symptoms. Triggers can include sunlight, medications and various infections.

Sometimes the correct diagnosis can be difficult to determine if the person doesn’t have typical symptoms, so referral to a rheumatologist may indeed be the best way to go for a thorough evaluation, diagnosis and treatment.

Treatments include various medications to treat the acute symptoms as well as prevent recurrence of symptoms. One of my patients with lupus has found that elimination diets work well for her, as she avoids eggs and grains and that seems to help substantially.

In addition, direct sunlight and the heat can worsen symptoms, so adequate hydration, liberal use of sunscreen and proper clothing can be a big help.

Multiple sclerosis is a disease of the brain tissue, in which the immune system attacks the myelin sheath (covering) of brain cells as well as spinal cord cells. The signs and symptoms can mimic many other conditions, so once again, careful and thorough exams as well as MRI (magnetic resonance imaging) may help distinguish this condition from others.

There are various forms of MS ranging from mild to severe and the earlier diagnosis and treatment begins, more often the better the outcomes.

The symptoms include fatigue, weakness, blurry vision, difficulty speaking, heat intolerance and any kind of nerve or muscle dysfunction, depending on what area of the brain is involved. Neurologists are the physicians who are experts in this area of treatment.

Lastly, rheumatoid arthritis is a kind of arthritis that is sometimes difficult to distinguish from osteoarthritis, the kind that happens from wear and tear of the joints.

Most often, in cases of RA, the person experiences tender, warm, swollen joints; joint stiffness that is worse in the morning and after inactivity; fever; fatigue; and loss of appetite.

This condition tends to start with the smaller joints, the fingers and toes, and may then move on to the larger joints on both sides of the body.

In almost half of people with RA, the condition spreads beyond the lining of the joints and symptoms may affect the skin, eyes, lungs, heart and other organs.

Again, a rheumatologist is most likely the expert physician who will provide care and treatment for people with RA, in coordination with your internist.

The intent of this overview of autoimmune conditions is to continue to raise awareness of many illnesses which may actually be quite invisible to others and yet cause serious dysfunction. Many times, people who look otherwise healthy may actually be in pain, may have trouble thinking or talking and may need our compassion and help.

Also, in case people are not aware, advances in the diagnosis and treatment of these conditions has progressed dramatically over the last few decades, so early evaluation and diagnosis are not to be feared.

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas. He can be reached at

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