Many medical conditions are considered autoimmune diseases. They are the result of an overactive immune system, and the body essentially “attacks” its own healthy cells. Autoimmune diseases can affect any organ or body system, depending on the condition. Examples of autoimmune diseases include rheumatoid arthritis, lupus, psoriasis, inflammatory bowel disease, vasculitis, thyroiditis, multiple sclerosis, and several other conditions. Symptoms of autoimmune diseases can vary drastically from one condition to the next, and even between patients with the same condition, depending on which tissues and organs are affected. Some non-medication interventions are useful for the treatment of autoimmune disorders, including physical therapy and lifestyle and diet changes. However, in most cases, autoimmune diseases require some sort of medication treatment. The goal of therapy is to control symptoms, reduce inflammation, control the disease process, prevent/slow down organ and tissue damage, and improve functioning/quality of life. Medications used to treat autoimmune disorders include pain relievers, anti-inflammatory medications, and drugs that suppress the immune system.
Non-Steroidal Anti-inflammatory Drugs (NSAIDs) block the body from making inflammatory chemicals to decrease pain and inflammation. They may be taken on an “as-needed” basis, or, under close medical supervision, daily to control the long-term pain and inflammation often associated with autoimmune diseases. Examples include ibuprofen, naproxen, aspirin, celecoxib, diclofenac, meloxicam, and indomethacin. These are usually taken orally. There is a topical diclofenac gel available for local pain relief.
Corticosteroids (aka- “steroids”) are drugs that resemble the naturally occurring hormone, cortisol. They “calm down” the immune system and decrease chemicals in the body that cause inflammation. Examples include prednisone, dexamethasone, methylprednisolone, hydrocortisone, betamethasone, and triamcinolone. They can be administered topically for the treatment of autoimmune skin conditions, as well as by mouth or intravenously for systemic (inside the body) treatment. It is best to use steroids for short-term treatment due to the risk of serious side effects with long-term use. Corticosteroids are often used to treat a disease “flare” (increase in symptoms for some time) or to help get initial disease control after diagnosis.
Disease-Modifying Antirheumatic Drugs (DMARDs) act in several different ways to suppress the body’s immune response and to modify disease progression, as the name indicates. They may be general immune suppressants, work on a certain pathway in the body’s immune response, or act on specific proteins in the immune system. DMARDs are classified as traditional or biologic. Since they work in different ways, one DMARD may provide disease control when another one doesn’t. So, you may need to try multiple medications before finding one that works best for you. A biologic agent will usually be prescribed when traditional DMARDs either don’t provide adequate control of symptoms or disease progression or if there are serious or intolerable side effects. Examples of traditional DMARDS include chloroquine/hydroxychloroquine, methotrexate, azathioprine, leflunomide, sulfasalazine, cyclosporine, and cyclophosphamide.
Biologic DMARDs are made up of proteins and target a specific molecule or pathway in the body that causes inflammation. They are generally more effective than traditional DMARDs. However, they may have more serious side effects and are more expensive. Most are given by injection or IV infusions, but there is one new medication that is available as a pill. Examples of biologics that treat autoimmune disease include adalimumab, etanercept, golimumab, infliximab, rituximab, ixekizumab, secukinumab, ustekinumab, abatacept, dupilumab, and tofacitinib.
It is important to remember that while NSAIDs and steroids often provide quick symptom relief (within a few hours to days), it will take a few weeks for DMARDs to be effective, and to determine whether a particular DMARD will work for you.
Common side effects that you might expect while taking medications to treat autoimmune diseases include:
-nausea/vomiting -increased or decreased appetite
-heartburn -mood changes
-stomach pain -restlessness
-constipation -fluid retention/swelling
-diarrhoea -injection site redness, swelling, irritation
-dizziness -increased risk of infections
-headaches
There are possible serious side effects to be aware of when taking these medications.
–Heart attack/stroke risk- There is a slightly increased risk of heart attack and stroke with NSAIDs, and some biologics may increase the risk of developing blood clots. Seek medical attention right away if you experience chest pain, severe headaches, one-sided weakness/numbness, or sudden pain, warmth, and redness in an arm or leg.
–Infection risk- Since corticosteroids, traditional DMARDs, and biologics all suppress the immune system, there is an increased risk of infections when taking these medications. It is important to maintain good hand-washing practices, consider masking during periods of increased infections such as COVID-19 and flu in the community, and avoid contact with people with known infections. Biologics carry a more significant risk for severe infections. Seek medical care when you have signs of an infection such as fever, chills, shortness of breath, severe headache, or sore throat.
–Gastrointestinal bleeding- Some of these medications, especially NSAIDs, can increase the risk of bleeding in the GI tract. You should seek medical attention right away if you have blood in your vomit or faeces. It may look bright red or can cause black, tarry stools, or a coffee ground appearance in vomit.
-Long-term use of corticosteroids can increase the risk of developing osteoporosis, which increases the risk of fractures, and Cushing Syndrome. This can cause weight gain, fatty tissue deposits, and increased hair growth, among other symptoms, and can increase the risk of heart disease, osteoporosis, and type 2 diabetes. This is why short-term use of steroids is recommended.
-It is very important to visit your doctor regularly and have routine bloodwork done when you are taking these medications because they can cause low blood counts, which increase the risk of bleeding and infection, as well as liver or kidney damage. These side effects can usually be detected before they become problematic with lab values determined from bloodwork.