Autoimmune Disease by Hope Starkman, MD


As a rheumatologist, I treat many autoimmune disorders. I am asked almost every day to explain to my patients what it means to have an autoimmune disease.

Our bodies have an inherent mechanism of protection against various organisms, infections and foreign cells which may include bacteria, viruses, fungi or cancer cells.  By having self-protection, we have immunity to infections and cancer. Occasionally, and for unknown reasons, our immune system malfunctions and we develop autoimmune disorders. When this happens our body, which usually produces cells and chemicals to help protect us from foreign agents, starts attacking our own cells. This form of dysregulation may result in   deterioration of our own bodily function involving most organ systems. Different autoimmune disorders affect different organs. The same dysregulation of our self-policing can result in the development of malignancies.

In terms of autoimmune diseases some of the most common ones include Rheumatoid Arthritis, Lupus, Polymyositis. What these inflammatory disorders have in common is that they often involve joints causing arthritis and muscle. They may involve   other organ systems as well including the heart, lung and its lining, kidney, liver, gut and nervous system. Without a system of checks and balances major disability and even death can ensue.  Autoimmune disease may also affect our endocrine glands and then we can develop thyroid disease and diabetes. The skin, which is the largest organ of the body is, often affected in autoimmune disease, as well, and is also often the first organ to demonstrate abnormalities visibly. Vitiligo is another very common autoimmune skin disorder which causes irregular pigmentation of the skin.

It is not known exactly what factors cause the onset in autoimmune disorders. It is clear, that, both genetic(inherited) factors and environmental factors such as infection, stress or trauma can trigger and perpetuate these autoimmune conditions.

Treatments of these conditions vary greatly and depend on the patient’s presentation, intolerances and prior failed therapies. Sometimes treatment is not necessary and a watch and wait approach can be appropriate. More often, however, medications are needed to interrupt this cascade of events that leads to major organ dysfunction. Since these medications target the immune system, they may result in weakening the body’s own natural defense against. Unfortunately, the treatment of these conditions, can, thus, lead to infection and malignancy. There is a delicate balance between control of the autoimmune disease process and opening the body’s defense to unwanted invasion which can cause other illnesses. For this reason, it is very important for patients with autoimmune disorders, such as Lupus to obtain care from a specialist, on a regular basis, such as a rheumatologist who is board certified in their specialty, who has an in-depth knowledge of the specific conditions and the therapies used to target those conditions.  Obtaining care from the correct socialist can mean the difference between ability and disability and between life and death.