Health Interview

Our immune system is meant to protect us, but sometimes it doesn’t work as it should. Autoimmune diseases, such as rheumatoid arthritis or lupus, can affect how our immune system responds to even healthy organs. Sun Health continues chat with Consultant Rheumatologist ,Dr Gaone Ditlotlo to learn more about how rheumatologists help patients with autoimmune diseases.

What are the most common misconceptions about autoimmune diseases like lupus in our society? What I have observed about Autoimmune diseases including SLE/Lupus is that most people have not heard of them and therefore do not know the symptoms and signs to look out for. This therefore leads to delayed diagnosis and treatment, which is also made worse by the fact that the conditions are complex and may present with symptoms that are seen in other conditions as well. The symptoms may evolve overtime and making a diagnosis may require several visits with a Rheumatologist.

How often do you see that food sensitivities are contributing to autoimmune processes? How does diet impact autoimmune diseases? There is no clear cause for Autoimmune diseases. However diet is important.

Are autoimmune diseases reversible? Autoimmune diseases are not reversible, but the aim of treatment is for the patient to be in Clinical remission whereby their disease is under control and there is minimal or no symptoms at all.

Treatment used, (known as immunosuppressants) controls/ suppresses the immune system such that it does not produce antibodies that attack healthy tissues What the common autoimmune disease symptoms people should pay attention to? The common Autoimmune (Rheumatological) symptoms include arthritis, skin rash, dry eyes, dry mouth, hair loss, muscle weakness, oral ulcers, change in colour of skin when exposed to cold weather And the risk factors that can increase the chances of developing autoimmune disorders? Risk factors for Autoimmune disease include: • Genetics- Some conditions tend to run in families • Gender- Females are more affected by Autoimmune diseases and this indicates that hormones especially oestrogen play a role in development of Autoimmune diseases • Having an Autoimmune disease- A person can have more than one Autoimmune Disease, hence the presence of one Autoimmune disease increases the risk of developing another • Smoking and other environmental toxins- Smoking has been proven to be one of the environmental factors that induces the production of Antibodies. • Certain Medications- Some medications have been shown to cause symptoms of Autoimmune diseases eg Drug Induced Lupus • Infections- some infections can trigger the onset of Autoimmune Diseases

I got in touch with you recently after one of your patients pointed me in your direction. She suffers from polymyositis. Explain to us what polymyositis is? Is it a form of arthritis? Polymyositis is one of the conditions called Idiopathic Inflammatory Myopathies. The other conditions being Dermatomyositis and Inclusion Body Myositis.

They cause muscle inflammation. These conditions are Autoimmune in nature. Polymyositis is differentiated from Dermatomyositis by the absence of rash found in Dermatomyositis. Polymyositis is characterized by inflammation of muscles with resultant muscle weakness. The muscles normally affected are those around the shoulders, hips, thighs and neck. The muscle weakness is proximal and usually symmetrical. Other muscles that can be affected include those of the upper oesophagus and phanynx. Polymyositis is a rare condition that affects females more than males. It usually affects adults from the 3rd decade onwards with a peak incidence from age 40-60 years.

What symptoms are associated with the condition? Symptoms of Polymyositis include easy fatiguability such that tasks that are normally easy, prove to be exhausting. There may be muscle ache (myalgia), weight loss and malaise (generally feeling unwell) It may be difficult climbing stairs, getting up from low chairs, carrying heavy objects, raising arms and even lifting the head from the bed or getting out of bed Patients may also have difficulty swallowing- they may complain of sensation of food getting stuck in the upper throat, and there may also be nasal regurgitation of fluids. This results in risk of aspiration of food and aspiration Pneumonia. The speech may also be nasal.

These symptoms are due to involvement of oesophageal and pharyngeal muscles, and they indicate more severe disease. Involvement of respiratory muscles- that is those of the diaphragm and rib cage, results in weakness of these muscles with weak respiratory effort and the patient will complain of shortness of breath and may end up having respiratory failure requiring assistance of breathing machines for adequate oxygenation. The lung tissue may be affected resulting in lung fibrosis and subsequent shortness of breath. Patients with Polymyositis may also have some joint pains with or without inflammation (pain, swelling, Early morning stiffness, loss of joint function)

The heart muscle may be involved and become inflamed. This may result in patients complaining of palpitations or chest pains and other symptoms indicating impaired cardiac function The symptoms of Polymyositis may occur insidiously over time getting worse as the disease progresses

How is it diagnosed? Breakdown the tests that one would have to undergo? Diagnosis of Polymyositis is based on Clinical presentation and investigations. Early diagnosis and treatment is essential for good clinical outcome. The major diagnostic criteria for Polymyositis/ Dermatomyositis is called the Bohan and Peter Diagnostic Criteria. These include: Proximal muscle weakness- Weakness of muscles of the shoulder/ pelvic girdle and neck muscles Elevated serum muscle enzymes-

These are markers of muscle inflammation, and they are elevated in patients with active disease Abnormal Electromyography results- The body makes muscles contract by electrical discharges from nerve endings at muscle membranes. An inflamed muscle will result in an altered electrical activity Muscle biopsy- A sample of the inflamed muscle is taken and analyzed in the lab to identify characteristic features of muscle inflammation seen in Polymyositis Polymyositis is classified as ‘definite’ in the presence of 4 criteria, ‘probable’ with 3 criteria and ‘possible’ with 2 criteria.

Laboratory tests Muscle enzymes- There are many causes of elevated muscle enzymes so these should also be ruled out when investigating a patient for Polymyositis Antibodies-Specific antibody tests should be done as some (Myositis Specific Antibodies) help to predict clinical manifestation and prognosis of the disease It is important to perform age and sex appropriate malignancy (cancer) screening as Polymyositis may be associated with cancer Chest X ray and High-Resolution CT scan to assess for lung fibrosis and its extent/severity if present Lung function tests to assess respiratory muscle function and lung fibrosis Echocardiogram and ECG to assess the effects of the inflammation on the heart muscle.