Tongue Twisting Branch

1. Who is a Rheumatologist or Clinical Immunologist?

Ans. Rheumatologist and Clinical Immunologist is a health professional who is trained in diagnosis and treatment of autoimmune conditions. They treat “diseases that can be inflammatory to non-inflammatory” and can affect any part of body from hair to toe but commonly affects joints, and muscles causing pain, swelling, stiffness and deformity.

2. What are autoimmune diseases?

Ans. These are diseases caused by “misfiring” of immune system. It starts attacking your own immune system going into self-destructive mode.

There is a long list of autoimmune diseases and common ones include Rheumatoid Arthritis, Ankylosing Spondylitis, Psoriatic Arthritis, Lupus, Sjogren Syndrome, Systemic Sclerosis, Osteoarthritis, Fibromyalgia, Gout to less common ones including Vasculitis, Myositis, Sarcoidosis, Behcet Syndrome etc. Autoimmune diseases predominantly affecting lung, heart, kidney, eyes etc also fall under this category like interstitial lung disease, pulmonary Hypertension, nephritis, uveitis.

3. How do we recognize symptoms of autoimmune disease?

Figure 1 will guide you to some of these symptoms.

Fig 1: How to recognise if you have autoimmune disease?

Symptoms

• Joint pain & swelling

• Lasting for more than 4 to 6 weeks
• Swelling

• Morning stiffness

• Back pain that is more on rest or in morning

Symptoms

• Rash

• Oral or genital ulcer

• Hair fall

• Redness in eye

• Dryness of eye or mouth

• Parotid swelling

• Blue or red or black fingers

• Stroke or paralysis particularly in young

• Recurrent abortions

• Unexplained or recurrent fever

Investigations

• ESR

• CRP

• ANA

• ACPA

• Rheumatoid Factor

• High or low WBC count

• Low Platelet

• Abnormal urine reports with protein

• Positive ANCA

• ECHO showing pulmonary hypertension

• CT showing lung fibrosis or lymph nodes

4. Do they occur in old?

Ans. It can occur in any age group. Some diseases are more common in childhood like autoinflammatory diseases, some in young reproductive age group like lupus and some in old age like osteoarthritis.

5. Is it genetic?

Yes, it can be genetic but not as common as hypothyroidism, or diabetes running in the families. There might be an increased risk but often you may realise you are the only one affected.

• It is contagious? No, it is not.

• Could it be because of diet related issues?

Lack or excess of any diet does not result in autoimmune diseases. It is important that you maintain weight and have balanced diet. If you are allergic to any food item, you can avoid that. In gout, it is however advisable to stop red meat, fish, alcohol, cold drinks.

8. How is an autoimmune disease diagnosed?

Based on your symptoms and signs, your rheumatologist will decide necessary tests (Figure 1). It is not only important for us to diagnose your disease, but also assess its extent and disease activity for better management.

9. Is there a treatment? Is it lifelong?

Yes, there is treatment. Important is timely recognition. A number of medications are available that can be tailored for you to bring your disease under control and help you achieve good quality of life.

Treatment duration is determined by type of disease, and organs affected. Several diseases are like diabetes and hypertension but differ in one fact that when disease is well under control for a period, it gives us an opportunity to reduce medicines gradually.

1. Does smoking or alcohol increase risk of autoimmune diseases? Yes and should be avoided.

1. A doctor claimed to completely cure arthritis, whereas my Rheumatologist says it may take long and cure may not be possible?

Unfortunately, a number of rheumatological diseases cannot be cured or “uprooted”. We are still very far from that goal. Diseases like reactive arthritis may go completely into remission for more than half of the patients. But disease like rheumatoid arthritis may need lifelong treatment, depending on delay in diagnosis and how well it has been managed. It is a challenging situation since patient has to commit and ensure that he or she takes medications timely. But remember with currently available medications, you can live a good quality life, with good work productivity.

12. Can patients with autoimmune diseases take vaccine?

Yes, you can take vaccines including COVID. Discuss with rheumatologist, if you are supposed to receive a live vaccine.

13. Are patients with autoimmune diseases at increased risk for COVID?

There is no absolute increased risk but it depends on extent of disease, medications, other comorbidities and disease activity.

14. Do infections like COVID lead to autoimmune diseases?

We still do not know the perfect answer. But lot of individuals complain of fever, fatigue, raised ESR, CRP, joint or muscle pain and should consult us. This can happen even after vaccine.

Conclusion

Early recognition of symptoms, timely diagnosis, optimised treatment, balanced diet and weight, exercises including yoga, good positive outlook, support from family and last but not the least your clinical immunologist and rheumatologist will help you stay fit, happy and healthy.

Dr Avinash Jain is a Clinical Immunologist and Rheumatologist trained from SGPGI, Lucknow and University of Birmingham, United Kingdom and works at SMS Medical college and hospital and CARES Clinic Mansarovar, Jaipur. April is being celebrated as Rheumatological diseases awareness month by Indian Rheumatology Association.