Saturday, August 13, 2022

Why Is Psoriasis An Autoimmune Disease

Autoimmune Skin Condition Symptoms

Psoriasis Risks: Autoimmune Disorders

The skin is the largest organ of your body. It serves as a protective barrier to the body against trauma. It also helps with many body functions like regulating your internal body temperature.

While the skin is made up of five distinct layers of skin, and the two top ones are most often affected by autoimmune skin diseases. The top layer is called the epidermis and it is the outermost layer. The underlying layer is the dermis and it contains vital cells, tissues, and structures.

These two layers are held together with proteins and other structures. When there is a separation of the two layers, blisters may form. These blisters can be small or large and contain fluid that contains dead or damaged skin.

Some blisters result from injury to the skin. With autoimmune skin diseases, blisters form because the body has created antibodies that attack proteins required for skin health and function. Sometimes, blisters can break open and become open sores.

In other autoimmune skin diseases, lesions can also form on mucous membranesthe esophagus, throat, inside of the mouth and nasal pathways, the genitals, and anus. Blisters can also cause gastrointestinal bleeding and problems with swallowing and breathing.

Conditions like psoriasis cause an overgrowth of skin cells that pile up on the surface of the skin. These plaques can burn, sting, and itch.

Other symptoms of autoimmune skin diseases include:

Reviewpsoriasis As An Autoimmune Disease Caused By Molecular Mimicry

Psoriasis is strongly associated with streptococcal throat infection, and patients have increased occurrence of such infections. Psoriatic lesional T cells are oligoclonal, and T cells recognizing determinants common to streptococcal M-protein and keratin have been detected in patients blood. We propose that CD8+ T cells in psoriatic epidermis respond mainly to such determinants, whereas CD4+ T cells in the dermis preferentially recognize determinants on the streptococcal peptidoglycan that might itself act as an adjuvant. The streptococcal association might reflect the concurrence of superantigen production promoting skin-homing of tonsil T cells, M-protein mimicking keratin determinants, and adjuvant effects of the peptidoglycan. Accordingly, improvement of psoriasis after tonsillectomy should be associated with fewer T cells that recognize keratin and streptococcal determinants.

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Points To Remember About Autoimmune Diseases

  • Autoimmune diseases refer to problems with the immune system, which usually fights off viruses, bacteria and infection. The problem causes your immune cells to attack your body by mistake.
  • These diseases can affect almost any part of the body.
  • In most cases, your doctor will prescribe medications to reduce redness, pain, and swelling.

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Genetic And Epigenetic Findings Of Autoimmunity In Psa

2.1.1. Human leukocyte antigen associations

Given their strong risk association, explaining the functional role of the HLA risk alleles, particularly the HLA-C*06:02, is essential for elucidating the pathogenesis of PsA. A fascinating case study with a unique methodology identified ADAMTS-like 5 as an HLA-C*06:02-presented melanocytic autoantigen to the lesion-infiltrating autoreactive CD8+ T cells in psoriasis . More interestingly, peptide motifs of the HLA-C*07:01, -C*07:02, and -B*27, which are three of the other psoriasis risk-related leukocyte antigens, utilize the same anchor residues with the HLA-C*06:02, have overlapping peptide-binding properties, and belong to the same HLA supertype . Synovial/entheseal counterpart of this picture is yet to be studied but seems to be more complicated since different disease phenotypes in PsA exhibit different HLA associations and contribution of the HLA-C*06:02 polymorphism to PsA risk is lesser compared to psoriasis .

Undertreatment Of Psoriasis Is Common

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Dr. Yamauchi points out that many patients with moderate-to-severe psoriasis are undertreated. This may be less true of people with PsA, who now often begin therapy with a biologic however, diagnosis is often delayed, which is also an issue.

âIn psoriasis, undertreatment may happen because patients or providers arenât comfortable with biologics,â Dr. Yamauchi says. âSome think biologics are dangerous because thereâs the perception that they suppress the immune system. I explain that these agents target immune system pathways that contribute to psoriasis and its comorbidities and that biologics normalize them to control psoriatic disease and inflammation.â

Dr. Ogdie also emphasizes that treating psoriatic disease improves quality of life. âMany patients assume theyâre fine, but until their inflammation is under control, they donât know how good they can feel,â she says.

If your skin isnât clear or nearly clear, or you continue to have joint symptoms or fatigue from PsA that interferes with your daily life, your systemic inflammation may not be well-controlled, says Dr. Yamauchi.

Talk with your health care provider about medications that can bring your psoriatic disease â and the inflammation associated with it â under control.

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Are There Other Risk Factors

People of color, children, and teens are at higher risk for mycosis fungoides, the most common form of cutaneous T-cell lymphoma. Itâs a slow-growing cancer that causes patchy, scaly, red skin rashes.

CTCL skin patches may appear lighter or darker than the rest of your skin if you are a person of color. Early on, your CTCL skin patches may be mistaken for psoriasis.

Pustular psoriasis is more common in people of Asian ethnicity than whites or other groups, and is more common in women than men.

The Whys Behind The Autoimmune Protocol: Nightshades

About Dr. Sarah Ballantyne, PhD

Award-winning public speaker, New York Times bestselling author and world-renowned health expert, Dr. Sarah Ballantyne, PhD believes the key to reversing the current epidemics of chronic disease is scientific literacy. She creates educational resources to help people regain their health through diet and lifestyle choices informed by the most current evidenced-based scientific research.

Tomatoes, potatoes , eggplants, sweet and hot peppers , and chili-based spices all come from plants which are members of the nightshade family. You may recognize several superfoods in this list of nightshades. However, nightshade vegetables are eliminated initially on the Autoimmune Protocol because, in addition to being packed with vitamins, minerals, fiber, and phytonutrients, they also contain several compounds that can drive inflammation and undermine gut health. This comes as a surprise to a lot of people when they first start learning about the AIP, so lets dig into the science!

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Could My Psoriasis Meds Cause Lymphoma

People with severe psoriasis may take methotrexate, a drug that lowers the immune system and has also been used to treat cancer. Itâs rare, but some people who take methotrexate can develop lymphoma or other bone marrow diseases years later.

People with psoriatic arthritis often take strong, immune-suppressing drugs like biologics, but they tend to have low rates of lymphoma. These medications calm the overactive immune system and inflammation in psoriatic arthritis. By doing so, they may also slow down the process that causes lymphoma. While immunosuppressants were once thought to increase your risk of cancer, recent research suggests that this may not be true.

While some research suggests that people who take TNF inhibitors do have higher rates of lymphoma, a large study from 2019 found that TNF inhibitors donât raise the risk of new or recurring cancer in people with psoriasis or other autoimmune diseases.

Psoriatic Arthritis Vs Rheumatoid Arthritis

Psoriasis: More than just a rash

If you have psoriasis and consistently experience joint pains and aches, you should see your healthcare provider. Thats because joint pain can be a symptom of psoriatic arthritis and rheumatoid arthritis both very real possibilities for people with psoriasis.

Indeed, a study published in the Journal of the American Academy of Dermatology in June 2021 found that adults with psoriasis experience an increased likelihood of having rheumatoid arthritis compared to adults without psoriasis.

Determining whether you have psoriatic or rheumatoid arthritis can be challenging, but making the distinction is important, says Natalie E. Azar, MD, a clinical assistant professor of medicine and rheumatology at New York University Langone Medical Center in New York City.

Although rheumatoid arthritis and psoriatic arthritis share many traits joint pain, stiffness, swelling they also have unique symptoms. For instance, psoriatic arthritis symptoms can include a skin rash as well as nail damage.

Its important to distinguish which type of arthritis you have to manage it well and know what to expect, Dr. Azar says.

Although treatment options can be strikingly similar, Azar says, significant advances have been made in the development and discovery of new biologic therapies very specifically for psoriatic arthritis.

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What Are The Types Of Psoriasis

There are different types of psoriasis, but the most common kind isplaque psoriasis. It appears as raised, red patches of skin that are covered by silvery-white scales. The patches usually develop in the same pattern on both sides of the body and tend to appear on the:

  • Scalp.
  • Limbs, especially the elbows and knees.

The Bodys Defenses Gone Rogue

Researcher Nehal N. Mehta, M.D., MSCE, is a senior investigator in the Section of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute in Bethesda, Maryland. For the past six years, he and other scientists in his NHLBI lab have followed a group of 350 people with plaque psoriasis, looking into how chronic inflammation affects their risk of heart disease and metabolic conditions such as diabetes.

âInflammation is simply a collection of immune cells trying to put out a fire, and that fire is usually an infection or some sort of virus,â says Dr. Mehta, a cardiologist and internist.

Setting off this inflammatory response, infiltration of immune cells and release of factors, is what the immune system evolved to do. In psoriatic disease, however, this primal defense has gone awry.

âIn psoriasis, immune cells attack places they shouldnât,â Dr. Mehta says. âThey go to the skin and cause psoriatic plaques, but they can also go to the joints and cause psoriatic arthritis. When they infiltrate blood vessels of the heart, they inflame the cells that line blood vessels. These fill with immune cells that donât belong there and cause inflammation. Thatâs the beginning of cardiovascular disease.â

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What Questions Should I Ask My Healthcare Provider About Autoimmune Diseases

Its helpful to have some questions ready to ask before you see your provider. Examples to consider include:

  • Do I have an autoimmune disease?
  • What tests should I go through?
  • What type of autoimmune disease do I have?
  • Do I need to see a specialist?
  • What specialist should I see?
  • Whats the best treatment for me?
  • Should I let my family members know that I have an autoimmune disease?

When Should I Go To The Emergency Department

Psoriasis rash: Types, pictures, and symptoms

Go to the emergency department if any of the following autoimmune disease symptoms get severe:

  • Trouble breathing/shortness of breath. Remember that some people with an autoimmune disease can experience this when theyre pregnant.
  • Severe chest pain/pressure to your chest.
  • A headache that starts suddenly and feels like the worst headache youve ever had.
  • Sudden weakness, especially if you cant move.
  • Dizziness that doesnt stop.
  • Pain so severe that you cant stand it.

A note from Cleveland Clinic

Living with an autoimmune disease can be complicated. Diseases like lupus, rheumatoid arthritis and multiple sclerosis are complex and serious. Although there are no cures for these diseases, many of their symptoms can be treated, and sometimes they go into remission. Stay in touch with your healthcare provider about any advances in understanding and treating autoimmune diseases.

If you think you may have an autoimmune disease, see your healthcare provider as soon as possible for diagnosis and treatment. Your symptoms will be easier to control if the condition is treated promptly.

Last reviewed by a Cleveland Clinic medical professional on 07/21/2021.

References

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Psoriatic Disease Affects More Than Skin And Joints

The systemic inflammation that drives symptoms of psoriatic disease can raise your risk for other health problems.

If you have psoriasis or psoriatic arthritis , you may know that these diseases raise your risk for some other conditions as well. When one disease is triggered by or linked to another, the related condition is called a âcomorbidity.â PsA, for example, is a common comorbidity of psoriasis, affecting up to 33 percent of people with psoriasis.

According to the recent Joint AAD-NPF Guidelines of Care for the Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities, other comorbidities for which psoriatic disease raises risk include:

  • Cardiovascular disease
  • Mental health impacts, including depression and anxiety
  • Inflammatory bowel disease
  • Uveitis
  • Nonalcoholic fatty liver disease

Just how this elevated risk happens for each comorbidity isnât fully understood. One underlying factor that likely plays an important role in triggering or contributing to development of many comorbidities, however, is systemic inflammation, explains dermatologist Paul S. Yamauchi, M.D., Ph.D.

The weapons the immune system uses for this attack are inflammatory immune cells that normally defend the body from injury and infection.

Autoimmune Diseases: The Basics

There are more than 80 known types of autoimmune diseases, the National Institutes of Health saysand theyre complicated, to say the least. In fact, scientists are still trying to figure out what exactly causes them to develop in the first place. So far, experts believe that a combination of genetics and environmental factors are involved, per the NIH.

So that means if you have other members of your family who have autoimmune diseases, your risk is increased as well, says the NIH. Women also appear to be at higher risk than men for autoimmune diseaseespecially African-American, Hispanic-American, and Native-American women.

Typically, the immune system works to fight off invaders in the body, like infection with viruses or bacteria, according to the NIH. But in people with autoimmune diseases, the immune system malfunctions and attacks the body even when its not supposed to. Autoimmunity can affect many different parts of the body, and often results in symptoms like fatigue, low fever, swelling, redness, and pain, the NIH saysmany of these symptoms are the result of inflammation triggered by the immune system. Some autoimmune diseases, like rheumatoid arthritis, can affect your joints, causing pain and stiffness. Others, like psoriasis, cause skin changes like itchy or sore patches.

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Why Psoriasis Is An Autoimmune Condition

Casey Gallagher, MD, is board-certified in dermatology. He is a clinical professor at the University of Colorado in Denver, and co-founder and practicing dermatologist at the Boulder Valley Center for Dermatology in Colorado.

Psoriasis causes a variety of symptoms that range from merely irritating to actually debilitating. The symptoms can include thick, red patches on the skin pitted, ridged fingernails scaly, itchy scalp and hair loss and stiff, painful joints.

Why do some people, but not others, get this frustrating condition in the first place? Arriving at an answer to this question relies partly on knowing that psoriasis is an autoimmune disorder “auto” meaning self and “immune” referring to the body’s complex immune system.

Treatments That Target The Immune System

What Is Psoriasis?

Treatment for psoriasis depends on the type and severity of the condition, your general health, and other factors.

Here are the various treatments that target specific factors in the immune system that cause inflammation. These are generally used when your psoriasis symptoms are moderate to severe. Note that the newer drugs are more expensive.

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How Do Autoimmune Diseases Affect You If You’re Trying To Get Pregnant

Some autoimmune diseases can affect your ability to get pregnant and some have adverse effects on pregnancy. You may need fertility treatments to get pregnant. You might also want to wait until your disease is in the remission stage to try to conceive.

There is a higher risk for stillbirth or preterm birth if you have lupus. If you have myasthenia gravis, you may experience trouble breathing.

Autoimmune Disease: Why Is My Immune System Attacking Itself

Autoimmune disease affects 23.5 million Americans, and nearly 80 percent of those are women. If youre one of the millions of women affected by this group of diseases, which includes lupus, rheumatoid arthritis and thyroid disease, you may be wondering why your immune system is attacking itself.

Ana-Maria Orbai, M.D., M.H.S., is a rheumatologist at the Johns Hopkins Arthritis Center. Rheumatologists specialize in diagnosing and treating musculoskeletal diseases and autoimmune conditions . Orbai explains several theories researchers have about what might cause autoimmune disease, including infection, tissue damage and genetics.

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How Are Autoimmune Diseases Diagnosed

Diagnosing an autoimmune disease usually takes healthcare providers longer than it does to diagnose other diseases. This is because many autoimmune diseases have similar symptoms with each other and with other diseases. You can help your healthcare provider with the diagnosing process by bringing the following to your appointment:

  • A detailed list of any symptoms and how long youve had them.
  • A record of your familys health history. Note if anyone in your family has an autoimmune disease.

In addition to interviewing you about your symptoms, your healthcare provider may do some blood tests to check for autoimmune diseases, including:

  • Antinuclear antibody test .

Specific symptoms combined with specific blood markers may prove that you have an autoimmune disease.

Saponins Enterohepatic Circulation And Fat

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Bile salts , which are produced by the liver, stored in the gallbladder, and then secreted into the small intestine after eating, are necessary to digest fats. They are created from cholesterol, which is converted into one of two types of fatty acid and then conjugated with the amino acids glycine or taurine to create a detergentlike structure . The majority of bile salts are reabsorbed by the small intestine and recycled back to the liver for reuse . Bile salts act as an emulsifier , by breaking apart large fat globules so that lipases can more effectively do their job. Bile acids also facilitate absorption of fats and fat-soluble vitamins by creating structures called micellesaggregates of fatty acids, lipids, cholesterol, and fat-soluble vitaminswhich are water soluble and easily absorbed by the enterocytes.

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