Autoimmune Disorders

Paul Reller, L.Ac.

Autoimmune disorders are both a growing problem worldwide and also a very underdiagnosed problem due to the complexity of the disorders and the wide variety of symptom presentations. Why are these health problems called disorders, rather than diseases or syndromes? This is because the diagnosis refers not to a specific disease but to a much broader problem of systemic general health. Autoimmune disorders are defined as disturbances of physiological function and/or tissue structures resulting from a combination of genetic propensity and exogenous factors such as the stress from disease, trauma, drugs and environmental toxins. Often these autoimmune disorders are linked to hormonal imbalances and chronic inflammation that stress the immune system and cause improper immune responses, or missense. These improper immune responses denote the term autoimmune, meaning that the body is applying immune responses and inflammatory mechanisms not to exogenous invaders of the body, but to the endogenous normal cells and tissues. The various mechanisms by which the immune system could mistake a normal cell for a cell invaded by a pathogen, such as a virus, or for a mutated, or cancerous cell, are still poorly understood due to the complexity of the system. As could be expected, a person afflicted with an autoimmune disorder often is found to be affected by more than one, and with such a dysfunction in the highly regulated immmune responses, other health problems related to immune function and tissue maintenance may also become a problem, such as cancer, cardiovascular disease, and neurodegeneration. Restoring homeostatic immune function is the primary goal when afflicted with autoimmune missense, not just managing symptoms.

The complex problem of autoimmune disorder requires a more complex solution than taking a single pill. Modern medicine has done little more than try to manage symptoms in these disorders to date, but the thoughtful patient understands that something must be done to correct the underlying health, as well as the disorder of the immune system. As in cancer treatment, modern medical specialists are turning to Complementary Medicine to help in the total package of effective care.

The NIH ranks autoimmune disorders as the third largest category of disease in the United States, behind cardiovascular disease and cancer. Worldwide, autoimmune disorder is now ranked as the most common cause of disease. Many believe that this is only the tip of the iceberg, as most autoimmune disorders are subclinical or undiagnosed. This should tell us something important. Namely, that the modern world is putting an incredible amount of stress upon our complex immune responses and that we should all do something to improve our health holistically to prevent this common dysfunction before it manifests as a serious problem.

The most well-known autoimmune disorders are Multiple Sclerosis, Rheumatoid arthritis, Hashimoto's Thyroiditis, Type One Diabetes and Psoriasis. Other disorders are becoming increasingly well-known, unfortunately. These include Angioedema, Vitiligo, Lupus, Scleroderma, Sjogrens, Polymyositis, Dermatomyositis, Graves, Addison's and Cogan's diseases. The list of autoimmune disorders is large, though, and surprisingly includes forms of endometriosus, Coeliac disease, COPD, Guillame-Barre, Myasthenia Gravis, schizophrenia, pernicious anemia, narcolepsy, and idiopathic thrombocytopenic purpura. In fact, many of the growing sets of allergic reactions are classified as autoimmune disorder, and the growing incidence of hypersensitivity disorders is clearly linked. Most autoimmune disorders actually begin unseen and asymptomatic, sometimes years before a clinical pattern of symptoms emerges. Allergies, hypersensitivity, and chronic inflammatory states, such as irritable bowel syndrome, often precede the diagnosis of autoimmune disorder. Many autoimmune disorders are secondary to other health problems and diseases. Understanding and prevention of immune missense could be the most important health focus of this century, and new Complementary treatment strategies are vitally important in this overall treatment protocol, and should be integrated into your standard care.

An October 6, 2008 article in the New York Times stated that experts now believe that Sjogren's syndrome is one of the three most common autoimmune disorders in the United States. This vastly underdiagnosed disorder affecting the secretory glands and other tissues, causes dry mouth, eyes, throat, and other membranes, as well as dry skin, tooth decay, trouble swallowing, depression, memory problems, neuropathy, thyroid disorder, and leads to increased incidence of bronchitis, sinusitis, skin rash etc. Patients with Sjogren's face a 44-fold increase in risk of developing lymphoma, a cancer of the lymphatic cells of the immune system. The 3 million patients diagnosed with Sjogren's syndrome in the United States today, 90% women, are believed to be a fraction of the total population afflicted with earlier stages of this disorder. Greater than 50 percent of patients diagnosed with Sjogren’s syndrome have acquired this autoimmune disorder secondary to another autoimmune disorder or disorders, often undiagnosed. Modern medicine still takes an average of 6 years to confirm the diagnosis after patients complain of symptoms to their doctor, underscoring the difficulty in properly assessing and treating autoimmune disorders. Modern medicine needs help. This help will come from Integrative and Complementary Medicine, such as Traditional Chinese Medicine (TCM), a medical specialty designed to treat both the symptoms and the underlying homeostatic dysfunction. TCM assesses each patient individually and makes a holistic diagnosis based on its specialized system, as well as a diagnosis based on modern tests and disease paradigms. This thorough and holistic system of diagnosis and assessment allows the physician to create treatment protocols that prevent the progression of autoimmune diseases from their early subclinical stages.

Diagnosis of atuoimmune disorder is very problematic. Various tests for antibodies and markers may detect a problem, but in many cases more than half of these tests are negative when the diagnosis is positive, while many subjects in clinical study, with positive tests, still do not present with a clear diagnosis. Sometimes a more invasive test, like a tissue biopsy, must be performed, and often, the doctors must depend completely on signs and symptoms and a diagnosis of exclusion. These tests are rarely ordered, and if the symptoms are unclear, the patient often refuses such invasive tests. As in many systemic disorders, underdiagnosis is often linked to the lack of an effective treatment, as well. If the big pharmaceuticals have not produced a pill for the problem, diagnosis is discouraged, and the insurance companies are reluctant to approve the necessary tests and specialist consults. If the most effective treatment studied lies outside the realm of standard medicine, medical doctors often do not pursue the diagnosis. A wait and see attitude prevails, until the stage of the autoimmune disorder reaches a level where harsh drug therapies are warranted. The drugs used to treat autoimmune disorders are for the most part immune suppressant drugs, which themselves cause many serious health problems. Today, finally, we see a number of rheumatologists incorporating Complementary Medicine into their practice. Patient demand with understanding of their disease will drive even more integration of Complementary Medicine in the years to come.

Autoimmune disorders, and the treatment of autoimmune disorders, presents the patient population with considerable risk of comorbid conditions, sometimes life threatening. A November 26, 2011 online early publication of a large Swedish study of autoimmune disorders and the incidence of pulmonary embolism, or a life-threatening blood clot in the lungs that may lead to stroke or heart attack, as well as lung disease, showed that during the first year following hospitalization for an autoimmune disease, the relative risk of a pulmonary embolism was over 6 times that of the normal population, with increased risk extending for 10 years. This study reviewed over 500,000 patients admitted to hospitals for an autoimmune disorder without a prior history of venous thromboembolism. The findings suggested that the autoimmune disorders most asociated with this high risk of a life-threatening pulmonary embolism were thrombocytopenic purpura, polyarteritis nodosa, polymyositis or dermatomyositis, and systemic lupus erythematosus (Lancet, Nov 26, 2011 doi:10:1016/S0140-6736(11)61306-8; Bengt Zoller MD et al). The exact reasons for increased risk of pulmonary embolism in autoimmune disorders was not made clear, but the fact that the common medications used to treat these disorders, namely synthetic corticosteroids (Prednisone et al), increase the risk of pulmonary embolism dramatically, is the most likely reason for this high risk with hospitalization for these autoimmune disorders, which typically are first treated with a high dosage of prednisone or other synthetic corticosteroid medication. The logical answer to this increased risk of comorbid life-threatening health problems would be to try to reduce the dosage as far as possible of prednisone or other synthetic corticosteroids. This could be achieved easily with integration of Complementary Medicine. The answer to the problem in standard medicine in the United States, though, is to continue with the high dosage of prednisone or other synthetic corticosteroid, and to have the patient take a thoracic CT scan, a high dosage or radiation that comes with considerable long-term risk of cancer, and then to add more problematic pharmaceuticals when signs of lung fibrosis occurs, as well as to prescribe a number of medications to inhibit clotting, a natural mechanism of the body to help repair vascular damage from inflammation. This adherence to a protocol of increased medication risks rather than decreased prescription and integration with Complementary Medicine in the treatment of autoimmune disorders is creating much anxiety in the patient population today, as well as a growing number of medical doctors that specialize in autoimmune or rheumatic diseases.

The integration of Complementary Medicine to achieve better outcomes and quality of life for the patients with autoimmune disorders is a sensible approach. This Integrative Medicine could decrease medication side effects, comorbid risks, and increase quality of life for the patients. Even better, Integrative Medicine can be used to prevent autoimmune disorders, especially when these patients are identified for increased potential risk. As more and more research identifies biochemical and genetic markers for potential risk, and the patterns of ill health associated with increased risk of autoimmune disorder is elucidated, the potential to prevent these disorders, which are increasing in frequency in the population at an alarming rate, is great. For the patient, preventive medicine of a holistic nature is the sensible course of action to address the issues of autoimmune disorders, and if an autoimmune disorder is suspected, prompt care from a Complementary physician may be the key to avoiding a disabling health problem in the future, and progression of the disease mechanisms. The therapies in Traditional Chinese Medicine are for the most part supportive of healthy immune function, modulatory, and safe, not suppressive of normal immune function. This comprehensive treatment stategy has minimal chance of adverse side effects, and is restorative. The possibility that acupuncture, herbal and nutrient medicine will interfere with standard therapy when a knowledgeable Licensed Acupuncturist and herbalist is integrating this protocol is extremely minimal, almost unheard of.

Herbal research is producing promising and safe treatment for autoimmune pathologies. Dr. Frederick Vivino, a rheumatologist at the University of Pennsylvania Medical Center, stated in the aforementioned N.Y. Times article, that “there is a growing interest among pharmaceutical companies in biologic (herbal) remedies that could cause a remission of symptoms.”

Understanding Autoimmune Pathology

The area of underlying ill health and imbalance that is becoming more important in the understanding and treatment of autoimmune disorders is the hormonal, or endocrine, system. Nearly 79% of all autoimmune disorder diagnoses in the United States concern women, and many of these are diagnosed during the hormonal imbalances of the menopausal years or after pregnancy. The relationship between hormone regulation and healthy immune function has led to a huge increase in scientific study and many promising therapeutic results. The field of neurohormonal immunology is expanding rapidly. Some of this information is presented later on this webpage. But this is not the whole area of concern, and a basic understanding of the complex interactions of the cytotoxic (innate cell-mediated) and humoral (learned antibody dominant) immune interactions is important in the understanding of autoimmune disorder.

Much of our immune response involves the cytotoxic immune system. Cytotoxic refers to cyto- or cellular, and toxin, meaning a noxious substance that is formed as an integral part of a cell or tissue. This part of our immune system constantly explores and learns of cells that are a threat to our health and attacks these cells or tissues. It creates antibodies that attach to these cells or tissues which trigger complex immune responses, generally utilizing the complement system, or sequences of immune modulating chemicals, typically called kinins. Because of the complexity of this cytotoxic immune system, much can go wrong. The problems in the cytotoxic immune system may occur in the formation of immune cells, altering of these immune cells by foreign chemicals or protein fragments, deficiencies of nutrients necessary to supply all of these cells, hormonal regulation of the cells, excess stimulation by free radicals, or oxidative stress, or the inability of the immune system to properly identify new viruses and retroviruses that enter cells deep in the body. Because all of these factors may be present in a particular case, a holistic and comprehensive approach must be taken.

Many of the responses of the cytotoxic immune system are related to viruses. Viruses that are deep and chronic may also provoke the autoimmune response. Viruses are not living organisms, but rather bits of coated DNA or RNA that enter our cells and alter them, expressing more viruses or triggering exression of chemical mediators. Our immune system must identify these altered cells and tag them with antibodies in order to distinguish them from normal healthy cells. In the same way, our cytotoxic immune system may tag tissues and cells that are altered with environmental toxins and drugs, as well as bacterial lipoproteins on the membranes of bacteria in deep low-grade bacterial infections. The cytotoxic and humoral immune systems interact to accomplish these tasks. This reaction to altered cells and tissues may take the form of an allergic response, or it may take the more serious form of an autoimmune response. There is actually little difference in allergic and autoimmune reactions as far as the mechanisms of immune responses are concerned.

The Humoral Immune Response (HIR) is also a key factor in many autoimmune disorders. Humoral refers to immune cells that circulate or reside in the body's humors, or fluids. B-cells make up the key components in the HIR, producing antibodies, or immunoglobin (Ig) proteins, as part of our adaptive immune system, that retains memory of antigens such as viruses. B-cells may also produce the auto-antibodies responsible for immune missense. B-cells are small lymphocytes, or white blood cells that are regulated and differentiated in our lymph, viscous fluid that is formed in our tissues and circulates via lymphatic vessels to lymph nodes, eventually emptying into our veins. B-cells are short lived white blood cells that produce antibodies that recognize cells not normal to our bodies, attach to the these cells, and destroy them by binding complement cells. They are differentiated from T-cells, which are cells with long lives (months to years), are regulated and produced in our thymus, are more guided by our immune memory, and destroy cells by producing specific proteins that destroy the cell capsule.

T-cells may work independantly from our antibodies, or immunoglobin proteins. Larger lymphocytes are called natural killer (NK) cells, and are the usual cells that respond to viruses. These NK cells are a type of T-cell that are not dependant on antigens, are part of our innate immune system of normal defense, and directly attack abnormal cells, be they cancerous mutations, or infected by viruses. B-cells are often implicated in the pathophysiology of autoimmune disorders, perhaps because they may be more easily altered and attack cells in a less controlled way than T-cells and NK cells. B-cells may also be invaded by viruses more easily, such as hepatitis C viruses. Common viral communities, such as hepatitis C types, may induce greater B-cell proliferation. Since B-cells are more closely defined by antibody production, they may also be the key factors in production of auto-antibodies, or proteins that attack normal cells of our body in autoimmune reactions. These auto-antibodies may be produced primarily because so many B-cells are infected with the various viral DNA or RNA that become symbiotic in the population, such as hepatitis C, which is now found in a majority of our population, or the ubiquitous Epstein-Barr virus. Epstein-Barr is a type of herpes virus that causes infectious mononucleosis, but since its discovery, it has been found in cell cultures of many diseases, including Burkitt's lymphoma, thus it's link to lymphocytes.

Our bodies produce proteins that help our immune system recognize a normal healthy cell and prevents the immune cells from attacking it. The part of the gene in each of our cells that controls this is called the major histocompatability complex, or MHC, and the genes expressing human leukocyte antigen, or HLA, are the main protectors of our cells against unwanted immune responses. Unfortunately, these HLA molecules may also be associated with autoimmune response, and the key question that arises is what turns a healthy leukocyte antigen to become dysfunctional. An antigen is an antibody generator. Antibodies are immune proteins that are circulated and help the immune system to identify and neutralize or destroy pathogens, such as viruses and bacteria. Immunoglobulin antibodies act as receptors to the B-cells mainly, and are called IgG, IgA, IgE etc. T-cells are often linked to the receptor imbalances, and are linked to creation of autoimmune antibody receptors. People with certain HLA antigens, or misshapen HLA alleles, are more likely to develop certain autoimmune disorders. An allele is one half of a gene. These genetic mutations would not condemn the person to the autoimmune disease, but may make them more susceptible to non-genetic factors that create cellular problems. These non-genetic factors include environmental toxins, deeply penetrating viruses, hormonal imbalances, excess physiological stress, inflammatory disorders, etc.

The subject of genetic susceptibility is not as simple as we would like it be, though. A significant percentage of healthy individuals in study have been found to test positive for anti-thyroid peroxidase antibodies in blood. Studies identify between 5-10% of the healthy population testing positive. A study cited below in additional information shows that the healthy humans with Hashimoto's antibodies did not experience the mechanisms of inhibition of thyroid peroxidase creation or function, and enzyme inhibition of thyroid peroxidase stimulation. In other words, even specific antibodies expressed genetically are found to have differing functions in the body depending on a variety of factors, and that for healthy subjects, antibodies were formed, but now these people may not be genetically expressing the variant genes needed to create the disease mechanisms. Once again, the disease must be seen in a more complex holistic manner to fully understand it and create a workable treatment and prevention protocol.

Certain chemicals and drugs may couple with normal proteins in the body to produce autoimmune reactions. Usually, the manifestation and diagnosis of this complicated response happens long after exposure to the drug or chemical, and linking the cause and manifestation of the disorder is difficult. Genetically, we may have inherited a predisposition to the creation of certain types of autoantibodies, and certain drugs and chemicals may trigger these autoimmune genes. Normally, autoimmune reactions should be restrained by specific regulatory T-cells that are part of the complement system. When the immune system does not function properly, or is overly stressed, these T-cells may be deficient, or dysfunctional. Antibodies may be structurally defective in production or altered by the chemicals that combine with these proteins. The number of possibilities of dysfunction that could cause specific autoimmune responses are large.

Because of this complexity of the cause and also the manifestation in autoimmune disorders, it is imperative that the patient gains understanding of their unique health problems and also takes a holistic approach to correcting the underlying problems that perpetuate the autoimmune response. Generally, the best outcome in these disorders have come with patients that improve their underlying health and reduced physiological stress. The most important areas to improve are the immune system and the endocrine, or hormonal system. Symptom management is vitally important in most cases, but improvement of the underlying health should not be overlooked. As always, understanding is a vital part in making the right choices in holistic therapy.

Theories of Autoimmune Pathology

Immunodeficiency Syndrome: Many experts contend that a lingering deep viral infection that is subclinical (no apparent symptoms directly attributed) stimulates a chronic immune response that depletes the body. Deficiency of the immune response, due to overstress or to an immunodeficiency pathology, many play an important part in the early stages of autoimmune pathology. Fungal overgrowth such as Candidiasis has been implicated as a contributor to immune stress, as well as yeast overgrowth and Giardia infestation. Spirochete population, as in Lyme’s disease, has also been implicated in some cases. The rising incidence of viruses that are difficult for the body to detect and the overuse of antibiotics, with an alarming number of antibiotic-resistant strains of bacteria have also been blamed for immune stress and acquired immunodeficiency pattern. Whatever the cause or causes, it appears certain that a chronic inflammatory state, poorly controlled by our immune system, is often a key factor in the development of the autoimmune response.
The free radical theory of autoimmunity is becoming very accepted in the research field of autoimmune pathology. A number of factors may cause increased oxidative stress that could trigger immune missense. For example, exposure to toxic chemicals may cause red blood cell damage and subsequent increased release of free iron, whose accumulation has been shown to cause the activation of immune responses and free radicals that could be linked to autoimmune disorder. Free radicals are small but highly reactive atoms or molecules usually composed of oxygen atoms paired with other elements that accumulate in the tissues and are difficult to clear. A radical is a small part of a larger molecule, and these free radicals do not easily become useful parts of other larger molecules, hence the term free. As they accumulate in tissues, they react negatively with the immune system and cause increased stress in immune reaction to clear these accumulations. The body has a wide variety of antioxidant chemicals that it creates or ingests in the diet to help clear these free radicals. The fact that there are so many antioxidants in nature reinforces that fact that this is a key factor in immune health.
Drugs and medications play an increasing role in accelerating autoimmune processes. It is argued that the amounts of genotoxic drugs and their adduct-forming metabolites probably play a pivotal role in accelerating autoimmune responses, depending on the genetic predisposition of the individual. The most common genotoxic drugs are used in chemotherapy, but a number of newer drugs that target specific genetic mechanisms are shown to be mutagenic and probably genotoxic as well. Some antibiotics, such as Ciprofloxacin, are found to be genotoxic. Antiviral and anti-retroviral drugs are shown also to present significant genotoxicity. As Americans consume ever larger amounts of new pharmaceuticals this potential cause of the rise of autoimmune pathologies should not be overlooked.
Viral infections and their role in immune missense. Viruses are not living pathogens, but rather bits of genetic material encapsulated by proteins. Theories explaining the origin of the virus point to the fact that they may once have been small cells within our bodies that acted like parasites for larger cells. Over time, this mechanism may have become vital to cellular evolution, and today an incredible variety of viruses and retroviruses appear in our world and alter our cellular mechanisms. A small percentage of these genetic alterations may be important for our survival, but a great number of them cause harmful conditions and stress in our bodies. In times of increased viral activity in the world, our immune systems must be strenghthened to adapt. Instead, we create conditions in our environment that overstress and deplete the capability of our immune systems. This overstress and depletion creates a much greater risk of autoimmune missense. Lingering pathogenic factors (LPF) are an important focus of research and treatment of autoimmune disorders. Viral DNA and RNA that are active and not perceived as normal to the cell genome will continue to be attacked by the immune system. As much as 80 percent of the human genome is comprised of genetic material from viruses, mostly inactive, called junk DNA. Recent research in genomics has discovered a surprising complexity to this viral genetic component of our cells, and the epigenome covering it. Some of this viral DNA and RNA continues to play an active role in gene expression, especially in relation to genetic coexpression and epigenetic coregulation. The cure for the automimmune reaction thus lies in optimizing health, both the complement system of acquired immune reaction and the hormonal health that works holistically to regulate cellular function and immune response.
Environmental chemicals and their role in the autoimmune process: (1) Heavy metals in the environment, particularly gaseous lead and mercury released from power plants, have been linked to autoimmune disorders for some time. While heavy metals in their solid natural form are usually non-toxic, industrial alteration of these metals make them highly toxic and able to become part of the food chain, water supply and parts of our common consumer items. The EPA has been very lax in real enforcement of restrictions on the use of heavy metals in industry due to intense lobbying and politics. Instead, the EPA and FDA has colluded with industry to mislead the public about the real sources of these toxic altered metals. (2) Other environmental chemicals are now known to be genotoxic, including small levels of common pathogens in processed meat, such as salmonella, which don't cause immediate illness but may trigger immune missense. Genotoxicity describes the ability of a chemical to deleteriously alter the cell genetic material. With the increase in products that are genetically engineered, use of radiation to preserve our food for transport, and the new classes of pharmaceuticals that work by altering genetic expression, this genotoxicity is a very real and growing threat to alterning our genetic predisposition to autoimmune processes. (3) The vast amounts of genotoxic pharmaceuticals that get dumped into our water supply creates a growing problem for us all, not just those that are taking these medications. (4) Some common genotoxic industrial chemicals are aromatic amines, such as aniline, which is also called phylamime or aminobenzene, and is a key component of polyurethane, used in many types of products. Examples of polyurethanes are resins, plastic polymers, paints, varnishes, building foams, flooring materials, textiles, seat cushions and upholstery fabrics. The evidence of harm is so convincing that we now see television ads for car manufacturers showing us how they are trying to replace their seat foam with a healthy alternative product. This is because the genotoxicity of many common products of our industrial civilization is becoming more well known and stimulating a demand for safer industrial products. Attacks on the Environmental Protection Agency (EPA), and dilution of their enforcement, has resulted in a lack of protection of the public by our government. A healthy business climate does not equate to an unhealthy consumer, and until our business leaders understand this, evironmental illness such as autoimmune disorder, will not be eliminated.
Hormonal imbalances and their link to autoimmune disorder: The overwhelming incidence of autoimmune disorders in women, occurring especially at menopause and pregnancy, suggest that hormonal levels play a key role in autoimmune disorders. Estrogen and prolactin play an important role in modulating the immune response, and prolactin has an immunostimulatory effect and may promote autoimmunity. This hormone has been shown to affect the maturation process of B lymphocytes and perhaps impair the negative selection of autoreactive B lymphocytes. Hyperprolactinemia is observed in multi-organ and organ specific autoimmune diseases like Sjogren's syndrome, Hashimoto's thryroiditis and Multiple Sclerosis, as well as non-organ-specific autoimmune disorders such as Systemic Lupus Erythrematosis, Rheumatoid arthritis, celiac disease and type one diabetes mellitus. High prolactin levels combined with low estrogen levels may cause depressive symptoms. This combination could also be linked to suppression of immune regulation. Researchers at the University of Genova, Italy, Division of Rheumatology found that localized lowering of immunosuppressive androgens and higher levels of immunoenhancing estrogens might determine the favorable condition for the development of rheumatoid arthritis (Autoimmunity Reviews Vol3, Issue 3, March 1004). Researchers at the Georgetown University Medical Center, Division of Rheumatology also found that the major stress hormones, such as cortisol, as well as the catecholamines such as epinephrine, are linked to both sytemic inhibition of inflammatory cytokines as well as local boosts of regional immune responses, and may suppress or potentiate autoimmune diseases and/or progression (Annals of NY Acad Sci.2002 Jun;966:290-303). Much research points to the links of hormonal imbalances and autoimmune pathology and suggests that endocrine health and balance, rather than specific hormone problems, is the key to prevention and treatment.
Thyroid imbalances in relation to autoimmune pathology: Of course, some significant autoimmune pathologies directly concern the thyroid, such as Hashimoto's thyroiditis, Graves' disease, and even non-Hodgkin lymphoma. The full association of the thyroid system to autoimmune pathophysiology is much greater. Autoimmune diseases have been implicated in the genesis of MALT (mucosal-associated lymphatic tissue) lymphomas throughout the body. These tissues in the skin, eyes, salivary glands, lungs, breasts, gastrointestinal tract and thyroid are highly populated by T-cells, B-cells, antibodies and cytokines that may be altered, malformed, poorly regulated or over-stimulated in autoimmune disorder. Specific autoimmune thyroid disease is seen mostly in women between 30-50 years of age, and 95% of cases of hypothyroidism associated with autoimmune disorder involve women. An amazing 2-4% of women worldwide are affected by autoimmune thyroid disease. Most of the cases of Hashimoto's thyroiditis change from hyperthyroid to hypothyroid, and hormonal deficiency and imbalance is obviously a key component in the overall pathophysiology of autoimmune disorders in general. Also, a large number of sufferers of Hashimoto's thyroiditis and hypothyroidism acquire other types of autoimmune syndromes such as vitiligo. Both T-cell and B-cell autoreactivity are seen in thyroid autoimmunity, and the lynmph nodes and bone marrow may also contain thyroid autoreactive lymphocytes. Specific antibodies may be detected in diagnosis, such as Thyroid Peroxidase Antibody (simple blood stick test), and this test is highly specific, with antibodies found in over 90% of patients with autoimmune hypothyroidism and Graves disease. These are mainly IgG antibodies and there is speculation that a connection exists with other IgG autoantibodies, such as in Coeliac disese, or overreaction to glutens. In addition to antibody testing, a simple lab analysis of thyroid hormones obtained with a blood stick test will elucidate the objective diagnosis. The Licensed Acupuncturist may order this relatively inexpensive test to speed diagnostic considerations in your Complementary protocol.

Therapeutic Protocols for Autoimmune Disorders

A comprehensive and holistic therapeutic approach seems especially important for treatment of autoimmune disorders, as evidenced by the wide range of probable systemic causes and aggravating factors. The Licensed Acupuncturist and herbalist, as well as other Complementary Medicine physicians, offer holistic and preventative medicine that is helpful in many ways in correcting and preventing autoimmune disorder of a systemic nature. Many times the patient does not perceive these therapies as dramatic, but decreasing chronic inflammatory processes, stimulating improved immune response, controlling Giardia and other unseen overgrowths and infections, improving liver health and detoxification processes, and a host of other benefits are routine aspects of care in holistic medicine. Complementary Medicine offers an array of therapies for both relief of symptoms and correction of underlying dysfunctions that cause these symptoms. Some therapies offered in TCM are dramatic, and patients with serious autoimmune disorders are sometimes amazed that they have finally found a way to improve their conditions after years of trying numerous specialists in standard medicine. Here are some of the many therapeutic protocols that have been seriously studied in recent years:

Estriol has been investigated as a symptom relieving and preventative therapeutic intervention in a number of autoimmune disorders, including rheumatoid arthritis, multiple sclerosis and autoimmune thyroiditis. A topical low dose estriol cream, properly prescribed may be beneficial to certain patients. The patient should rely on a knowledgeable physician to instruct and prescribe to insure that misuse does not lead to harmful effects or disruption of the menstrual cycle. A relative androgen deficiency and estradiol excess is often found in autoimmune disorders, and may be related to a deficiency of aromatase activity, with poor conversion of steroid hormones in peripheral tissues. DIM is a nutrient supplement that improves aromatase regulation and may help the body to correct this underlying hormonal problem. A 1992 study of patients with Lupus (SLE) noted that the aromatase activity varied inversely with the disease activity (Lupus 1992;1(3):191-5). Estriol, a less active but more abundant form of estrogen, applied locally, may alter this hormonal imbalance in peripheral tissues that drives a Th1/Th2 imbalance. Use of both DIM and estriol cream may be a useful tool in the treatment protocol.

Antioxidant therapies can protect against oxidative stress, chelate redox metals and act synergistically to create an antioxidant network to prevent overstimulation of the immune reactions to autoantigens. The most efficient enzymatic antioxidants are superoxide dismutase, catalase and glutathione peroxidase, and effective non-enzymatic antioxidants include flavonoids, alph-lipoic acid, beta-carotene, and vitamins C and E. The Licensed Acupuncturist has a variety of the best quality antioxidants available for use in nutriceuticals as well as herbal products. The quality of antioxidants commercially is proven to be highly suspect, and reliance on professional products is recommended. Methylselenocysteine is a potent antioxidant that has demonstrated efficacy in human clinical trials for various autoimmune disorders, including thyroiditis, Graves autoimmune and dermatomyositis.

Much research is being performed to identify herbal chemicals that are proven to be specific in both the treatment of autoimmune hyperreactivity as well as the modulation and regulation of the immune system. Much research points to the imbalance between two aspects of the immune T-cell system, the Th1 (T-helper cell class 1) and the Th2, in the pathology of many chronic autoimmune disorders, which allows a pro-inflammatory response to dominate the anti-inflammatory responses in immune regulation and tissue maintenance. This is a classic example of the yin and yang imbalances that Traditional Chinese Medicine see at the heart of all disease. The quality of the holistic care in the treatment of autoimmune disease completely depends on the knowledge of the prescribing physician, and the patient should choose wisely. Acupuncture research has also demonstrated positive effects concerning immune modulation (see study links below), and a combination of acupuncture and herbal medicine will work synergistically to create a more significant outcome.

Treatment utilizing bio-identical hormone therapy could be extremely helpful in many cases, and testing and appropriate care could be the key to success in therapy. Testing with cell metabolites in saliva and veinous blood samples has progressed dramatically in recent years, giving the patients and the Complementary Medicine physicians a relatively inexpensive way to objectively analyze the individual for signs of hormonal imbalance, as well as for antibodies and other markers of autoimmune disease. Laboratory analysis in these settings often provides a more holistic individualized analysis to better guide a complete therapeutic protocol utilizing Complementary and Integrative Medicine. Not only bioidentical estriol (mentioned above), but bioidentical progesterone, pregnenelone, and various phytohormonal chemicals, are routinely used in therapy today. The use of plant lignans to stimulate enterolactones and enterodiol may also prove to be of significant benefit in many cases.

To obtain a complete discussion of the therapies available in autoimmune disorder, please call and schedule an evaluation and cosult by this Complementary physician.

The focus of research on specific autoimmune mechanisms is illuminating the valuable roles of Complementary Medicine in the treatment protocol

The most striking fact that one consistently sees in scientific papers describing the pathology of autoimmune diseases is that they are still poorly understood. Nevertheless, in recent years, clues to the process of autoimmunity, which is always a complex, multifactorial, and staged set of pathological dysfunctions, has yielded new understanding to critical aspects of the complex immune cascade that could produce dramatic improvement in treatment protocols, and what is needed to affect and reverse the autoimmune process. These findings are not only applied to allopathic pharmacological research, but to research into how specific herbal and nutrient chemicals, and even specific acupuncture stimulations, may affect the autoimmune pathophysiology.

Mast Cells

Mast cells are perhaps the most important immune cells studied in relation to autoimmune disfunction. For instance, increased numbers of mast cells are found in patients with systemic scleroderma, rheumatoid arthritis, and are thought to drive the disease progression. When these increased numbers of mast cells are activated, they release a variety of chemicals, some of which regulated cell growth and differentiation. Heparin released from the mast cells is a potent stimulus for growth factors that cause the problematic tissue abnormalities in these autoimmune disorders. Mast cells are considered by many experts to be basophils, a class of white blood cells, that are homed in to specific tissues and cells. Like basophils, our bodies produce these specialized immune cells from stem cell precursors in our bone marrow. Unlike basophils, mast cells do not leave our bone marrow fully matured, or developed, but are genetically programmed to mature in specialized ways when encountering chemical triggers in specific tissues in which they will reside for their lifespan. The lifespan of a mast cell may vary considerably, depending upon both the tissue specific functions it develops, and the cell environment in which it resides. For instance, a type of white blood cell, the lymphocyte, has about a 30 minute lifespan in blood circulation, but when residing in a specific tissue, this lymphocyte may survive for years. While mast cells differ from lymphocytes (B-cells, T-cells and NK cells), they stem from a common precursor, and some types of mast cells, called P-cells, or persistent cells, also have the capacity for an unusually long life span.

We may consider mast cells the body’s main, or most important, immune cells. They are involved not only in allergic reactions and inflammatory responses, but relate to a wide variety of physiological and pathological processes. This diversity of differentiation, specialization, activation and the immune complement media that are produced from mast cells is strictly regulated, modulated, and controlled by our homeostatic mechanisms. The in-depth study of mast cells has helped us to better understand autoimmune processes, and also provides a valuable array of information that may guide the use of herbal and nutrient chemicals, as well as acupuncture stimulation, to correct this dysfunction of mast cell regulation and control. Acupuncture research has revealed the elaborate cascade of possible effects on modulation of immune responses. The effects of acupuncture on the nervous system, and the role of the autonomic nervous system on maintenance of immune homeostasis has brought to light the many ways that acupuncture stimulation itself may help to correct the autoimmune disorder. Of course, this type of reaction to needle stimulation, while immediate, often produces the complex desired result over time. It is not a form of magic. Symptoms are the end result of underlying physiological dysfunctions, and to truly eliminate symptoms in autoimmune disease, these underlying dysfunctions need to be corrected.

Acupuncture would work best in this regard in coordination with a comprehensive protocol, utilizing herbal and nutrient chemicals, and improvement in overall health and vitality. The cure in autoimmune disorders requires improvement in the healthy homeostatic functions of the body. Unfortunately, modern medicine limits treatment in autoimmune disorders to immune suppression to manage symptoms, and does little to even attempt to cure autoimmune disorders. Nevertheless, these immune suppressants may be needed when the autoimmune disease is threatening survival or function. The most common medication used, prednisone, or synthetic corticosteroid hormone, focus on suppressing the mast cell responses, but the wide array of effects of synthetic corticosteroids in the body make this drug problematic. The integration of Complementary Medicine and TCM allows the treating team to alleviate adverse effects of these drugs, provide support for improved physiological functions impaired by the disease mechanisms, perhaps reduce the need for high dosage of harsh drugs, and most importantly, to perhaps achieve a restoration of normal homeostatic immune mechanisms. Medical science is also now looking into markers of early stages of autoimmune dysfunction that may allow us to try to prevent the advance of these devastating disorders. Complementary Medicine provides an ideal protocol for preventive medicine in this regard.

Many types of allergic reactions activate mast cells to produce immune inflammatory or anti-inflammatory reactions. Type 1 hypersensitivity disorders activate mast cells and basophils inappropriately, and may lead to a chronic autoimmune reaction. Mast cells have specialized receptors on their membranes that allow them to interact with both B cells and T cells, as well as dendritic cells. Mast cells express the major histocompatibility complex (MHC) talked about above in this article. Mast cells also produce the cytokines (immune signaling chemicals) that regulate and control inflammatory responses. When a mast cell is activated it rapidly releases cytokines and hormonal mediators in the form of granules. A variety of triggers may stimulate this degranulation, including direct injury from trauma or chemicals, antibody cross-linking (e.g. IgE), or stimulation by immune complement proteins. The protein antibody that stimulates mast cells the most is the IgE (immunoglobulin type E), which is important to allergic response and hypersensitivity reaction. Mast cells have such a high affinity for this type of antibody that they are often covered with IgE, in irreversible bonds. As an individual acquires more and more allergic reactions and hypersensitivies to allergens and antigens, the mast cells are more affected by IgE. The abnormal expressions of these mast cells may then stimulate unwanted autoimmune responses.

When the mast cells degranulate, they may release a surprising complexity of molecules, including histamine, serotonin, heparin, protease, prostaglandin, leukotriene, thromboxane, platelet-activating factor, and various cytokines. These chemicals perform a variety of modulatory effects to stimulate either cell destruction, protection, maintenance or regrowth. The specialized mast cells exert these complex functions in our cells and tissues by interacting with the cellular and humoral environment, and the body needs to adjust, or modulate, this environment to achieve the correct mast cell response. Now, this very complex process may be impossible to regulate with man-made chemicals. Modern allopathic pharmacology is looking to affect just bits and pieces of this puzzle. Holistic medicine is seeking ways to help restore the complex evolved programming of the mast cells and their environment and triggers. This may seem like a daunting task, but research is revealing the many evolved mechanisms in nature that help our bodies achieve this task, and cure from the autoimmune disorder.

The pro-inflammatory versus anti-inflammatory role of the balance of T-helper cell types 1 and 2 (Th1/Th2)

T-helper cells are a sub-group of lymphocytes, a type of white blood cell, and provide the array of cell signaling chemicals we call cytokines, to properly regulate the array of inflammatory responses. T-helper cells are particularly important in signaling B-cells to change the production rates of the various types of antibodies. T-helper cell types 1 and 2 (Th1 and Th2) are particularly important in autoimmune pathology. Th1 provides the interferon (IFN-gamma) response, while Th2 provides the interleukin-4 and -5 (IL-4 and IL-5) that upregulate IgG4, IgA and IgE. T-helper cells activate and direct the growth of cytotoxic T cells, and maximize the activity of macrophages to destroy bacteria. When these T-helper cells are active they express the surface protein CD4, which is measured to monitor the progression of HIV. When the T-helper cell recognizes an antigen (foreign substance or toxin that generates an immune response, especially antibody production), it goes through a number of steps that may result in increased reproduction of T-helper cells, and the corresponding responses in the complex immune complement system.

Th1 will generate memory T-cell responses, as well as interferon and IL-2, within the cellular immune system, and is more partnered with the macrophages. Th2 will generate the B-cell responses with production of antibodies and memory B cells, within the humoral immune system. Each of these systems will stimulate and regulate the other, and generally, cytokines that stimulate a Th1 response will inhibit a Th2 response to provide a balanced array of cytokines to modulate inflammatory processes. Th1 will produce key cytokines associated with autoimmune processes, such as interferon-gamma (IFN-gamma) and tumor necrosis factor-beta (TNF-beta). Various interleukins are produced that stimulate specific immune or inflammatory responses during the phases of Th1 activation. Th2 will produce the interleukins IL-4, IL-5, IL-6, IL-10 and IL-13, stimulate increased B-cell activity, and antibody class switching. Normally, these two types of T-helper cell responses will maintain a safe and effective modulated immune response, so that cell and tissue destruction is not pathological. In autoimmune diseases, the Th1 to Th2 balanced responses become dysfunctional, and the search for the factors that contribute to this missense has yielded a number of answers.

Just as the role of mast cells in autoimmune pathological mechanisms presents a complicated array of potential malfunctions, the Th1/Th2 model of imbalance also is more complicated than we would like. The Th1 dominance over Th2 is seen in a variety of chronic inflammatory disorders. For instance, researchers at the Nerve-Gut Research Laboratory at the Royal Adelaide Hospital in Adelaide, Australia, found in 2009 that the Th1 dominance sensitized afferent neural responses in irritable bowel syndrome to create hypersensitivity, bowel dysfunction and pain, and an altered brain-gut response (PMID: 19566823). Over time, this chronic state of Th1 over Th2 immune imbalance could contribute to the slowly developing pathology in autoimmune disorder. Researchers at the Universidade do Grand Rio School of Medicine in Rio de Janeiro, Brazil, found in 2003 that Th1/Th2 imbalances may be the ultimate determinant factor governing the expression of IgE-mediated food allergies (PMID: 12839117). The role of mucosal and lymphoid interaction and dysfunctional immune responses concerning the Th1 dominance over the Th2 responses lies at the heart of current research into the origins of the autoimmune and hypersensitivity responses.

Complicating research into the pathology of autoimmune and hypersensitivity disorders is the finding that the stages of the disease show much different immune responses and imbalances. In many autoimmune disorders, the Th1 dominance over Th2 responses is seen in the early stages of the disease, but an eventual shift to a Th2 dominance is seen in the latter stages of the disease. This makes the reversal, or cure, of the autoimmune disorder particularly difficult, and the causes or contributors of this shift have been much studied, but are still elusive to modern science. In 1993, researchers at the UCL Medical School in London, UK, proposed a neurohormonal immune response, with peripherally activated prohormones that caused this shift in the Th1/Th2 paradigm.

Hormonal imbalances in autoimmune pathology

A number of common hormonal imbalances are linked to autoimmune disorders, often of a subclinical nature, or without clinically apparent symptoms. Hyperprolactinemia, localized androgen excess relative to localized estrogens, cortisol imbalances in a diurnal framework, and thyroid hormone dysfunctions are all important considerations in the understanding of the hormonal triggers and perpetuating factors that drive immune disorder. Poor function, or dysfunction, of the hypothalamus, thyroid and/or adrenals underlie many of these pathologies, and this is an important consideration in a holistic therapeutic protocol.

For the last decade, mild hyperprolactinemia has been considered a significant risk factor for the development of autoimmunity, especially with Rheumatoid Arthritis (RA) and Systemic Lupus Erythemematosus (SLE). Some instances of this hormonal imbalance are obvious, such as the acquiring of an autoimmune disorder postpartum, with adrenocortical deficiency, or even with aging. While hyperprolactinemia was relegated largely to suspicion of pituitary adenoma, or cancer, in the past, we now know that this hormonal imbalance is encountered at a relatively high rate in the general population. Autopsy studies have shown that hyperprolactinemia related to small pituitary lesions or microtumors occur at the rate of 5-20 percent in the population, and that the vast majority of these small tissue lesions or microtumors are benign and asymptomatic. In addition, other causes of hyperprolactinemia occur, including primary hypothyroidism, hypothalamic dysfunction or inflammation, chronic kidney failure, relative excess of estrogen (progesterone deficiency), and adverse effects from certain medications, including synthetic estrogens, dopamine inhibitors, and dopamine receptor antagonists. Dopamine inhibitors now make up a large class of medications, used to treat attention deficit and hyperactivity disorders (ADHD), obesity, depression, anxiety, Parkinson’s disease, addiction, sexual dysfunction, and now added to offset the adverse effects of chronic use of antidepressant selective serotonin reuptake inhibitors. In addition, the prescription of norepinephrine and dopamine reuptake inhibitors, as well as the prescription of serotonin-norepinephrine-dopamine reuptake inhibitors, is becoming more common.

While a short while ago modern medicine considered prolactin a hormone with a narrow effect, mainly stimulating breast milk, we now know that this hormone has many effects in the body. Prolactin secretion is pulsatory and has a diurnal secretion pattern, and prolactin binds to various receptors in the liver, lymphoid cells, and gonads (testicles and ovaries). In 2011, studies showed that hyperprolactinemia was also associated with hypertension and endothelial dysfunction (arterial disease), and that diurnal fluctuations of prolactin are associated with decreased endothelial function (American Journal of Hypertension 24, May 2011: 569-573). Circulating prolactin levels also have been shown to have a positive correlation with C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR), a primary marker in autoimmune disorders. Genetic study has revealed that prolactin may have a role in initiating or sustaining inflammation in rheumatoid arthritis (association with the HLA DR4 gene), but it is unclear whether this pathogenic excess prolactin is produced by lymphocytes or has a pituitary origin. Circulating antibodies to prolactin contribute to hyperprolactinemia in SLE (Marianne J. Legato, Principles of Gender-specific Medicine).

Neurohormonal imbalances are now the focus of research concerning subclinical hyperprolactinemia. Prolactin is a stress hormone, and increased mental or physical stress has been shown to affect circulating levels. Two hormones shown to be affected significantly by emotional stress are cortisol and prolactin, with cortisol surges related to shock, surprise and an active response to stress, and prolactin surges related to humiliating experiences, rage and a passive response to stress (PMID: 14674722). Dopamine has a dominant influence over prolactin secretion, and dopamine receptor imbalance may be tied to hyperprolactinemia. Hypothalamic peptides TRH (thyrotropin-releasing hormone) and VIP (vasoactive intestinal peptide) stimulate the prolactin secretion from the pituitary, and hypothalamic dysfunction or deficiency may affect prolactin secretion, as well as various immune and inflammatory problems. When symptoms occur, anovulation, infertility, missed menstrual periods, abnormal menstrual bleeding, abnormal lactation, vaginal dryness, diminished libido, erectile dysfunction, or gynocomastia may seen, although many or most cases may be asymptomatic and subclinical. No single test can help determine the cause, or underlying etiology, of hyperprolactinemia, and a thorough and comprehensive analysis should be made by an endocrinologist. Prolactin levels in circulation vary widely in various stages of the female life span, with the changes in the menstrual cycle, and change greatly in the diurnal cycle. This is problematic, and even in cases of galactorrhea, or abnormal milk production by the breasts, circulating levels of prolactin are often normal at the time the patient is tested. Tests analyzing free prolactin in circulation in a diurnal pattern produce more definitive values.

Adrenal insufficiency syndromes are of great concern with autoimmune pathology. Adrenal glucocorticoid hormones and neurotransmitters, or steroid hormones that bind to glucocorticoid receptors, normally dampen the immune reactivity. The most potent glucocorticoid hormone is the adrenal corticosteroid, or cortisol. Cortisol imbalance within a diurnal framework, or a disorderly secretion of cortisol in the day to night cycle, is a problem for both our brain function, and the immune function. Prolactin is a stimulatory link between the neuroendocrine and immune systems, and represents a hormonal focus for the study of the obvious links between hormonal imbalance and autoimmune disorder. Thus the effects of the stress hormones cortisol and prolanctin, both released in a diurnal fashion, seem most important in assessing neurohormonal balance and autoimmune disorder. We see that cortisol is produced mainly by the adrenal glands and prolactin mainly by the pituitary, representing both ends of the adrenal-pituitary axis. Addressing issues of adrenal insufficiency and adrenal stress syndrome has thus been a major issue in the treatment of autoimmune disease in the last decade.

Dr. John Lee, the pioneer of study of the bioidentical hormone therapies so much in use today, wrote extensively on the connection between hormonal imbalance and autoimmune disorder. Dr. Lee wrote: “Autoimmune disorders in general are thought to be triggered by transient viruses in susceptible people; the virus triggers antibodies against some protein component of the virus (the capsule). By some probably minor fluke, the antibodies attack similar proteins in certain body tissues...Corticosteroids block this attack by one’s own antibodies. One can hypothesize that estrogen dominance (relative progesterone deficiency) may have had a hand in triggering the errant antibodies, and thus correcting the estrogen dominance leads to a gradual correction of the problem. Progesterone is also the main precursor of corticosteroids and in progesterone-deficient women, restoration of the normal progesterone levels may enhance normal corticosteroid production, thus suppressing the autoimmune attack.” In Dr. Lee’s clinical practice, he observed the positive effects of correction of progesterone deficiency with bioidentical hormone creams and nutrient medicines in the treatment of autoimmune disorders.

In 2008, researchers at the National Institute of Mental Health, National Institutes of Health, in Rockville, Maryland, published an explanation of how glucocorticoids, such as cortisol, and progestins, such as progesterone, play a central role in the pathology of autoimmune disease (see study link below). These researchers stated that dysregulation of cortisol and progesterone may contribute to autoimmune and inflammatory disesases by failing to modulate inflammatory events within the feedback cycle between the adrenal-pituitary axis, the autonomic nervous system, and the central nervous system and the immune cytokine responses. They stated that recent studies have shown the important role of progesterone as an immune regulator, adding to the knowledge of the significant roles that cortisol, androgens, and estrogens play in the immunomodulatory cycle. In other words, Dr. John Lee appears to have been correct. Complementary Medicine, with its focus on the holistic aspects of this autoimmune pathology, also appears to have been spot on. In such a feedback cycle, involving the immune system, the CNS, and the endocrine axis, treatment has to be holistic, complex and individualized to restore homeostasis and cure the autoimmune dysfunction.

These NIH researchers stated: “Glucocorticoids play a crucial role in the immune response, from initial activation to eventual suppression and restoration of homeostasis. Emerging evidence indicates that progesterone also plays an important role outside of the context of pregnancy. When the actions of these hormones are impaired at the level of their receptors through changes of isoform expression or genetic mutations, the resulting dysregulation of the immune response many enhance susceptibility to development of infectious or inflammatory disease. As a result of the complexity of neuroendocrine-immune interactions, no single event that changes glucocorticoid receptor or progesterone receptor activity is likely to be responsible for the development of disease, but these host factors together can contribute to disease progression.” (Journal of Leukocyte Biology 2008;84:924-931).

Specific autoimmune disorders with rising frequency:

As we see a rising frequency of both diagnosed and undiagnosed autoimmune disorders in the United States, and in the world, we see that there is considerable incidence of a patient diagnosed with more than one autoimmune disorder, with one autoimmune disorder apparently caused by another, and a considerable variance in clinical symptom presentation and course of the disease for many autoimmune presentations. This does point to a need to view these autoimmune disorders primarily as a dysfunction of the immune homeostasis and not as much as specific diseases.

Angioedema (blood vessel swelling) is a symptom that may be related to an autoimmune disorder, and is characterized by swelling beneath the skin or in the mucous membranes, usually occurring in the throat, around the lips or eyes, or on the hands or feet. It is rapidly moving from a very rare occurence, to one that is increasingly seen in the United States population. Incidence has moved from one in 150,000, to one in 50,000, and is considered grossly underdiagnosed, due to the unfamiliarity with the disorder, and the difficulty in diagnosing. This disorder manifests in episodes, often short in duration, and sometimes alarming or life threatening. The episodes may come with some frequency and then dissappear for years. While many cases are diagnosed as inherited, or hereditary (HAE), even cases linked to specific genetic missense display a variety of types, are usually multifactorial in cause, and are poorly understood. Specific typing helps in the diagnosis, telling us differences in levels of control proteins, called C1, or C1-INH, which may or may not be abnormal, or whether estrogens play a significant role in the pathophysiology, but this typing mainly helps decide the pharmacological approach in allopathic medicine, which to date has been ineffective. The workable approach to treatment must focus on all of the underlying health problems and tackle the disorder with a comprehensive and holistic approach. Integrating Complementary Medicine, especially with acupuncture, herbal and nutrient medicine, may make a dramatic difference. Traditional Chinese Medicine is normally focused both on underlying health problems that cause or contribute to the pathology as well as symptom relief, and the array of treatments and medicines is broad and varied, unlike allopathic medicine. While angioedema is still downplayed as a symptom related to allergic reaction, in most cases the actual cause of the angioedema is never found, and the syndrome is termed idiopathic. It is true that acute angioedema may be caused be an allergic reaction to medications (antibiotics, especially sulfa drugs, NSAIDS (nonsteroidal anti-inflammatory drugs), and blood pressure medications such as ACE inhibitors), by allergic reactions to insect bites, pollen, animal dander, or a variety of foods, or by exposure to extreme cold or heat, chronic cases of angioedema usually fall within the category of an autoimmune disorder. Episodes of difficult breathing due to airway obstruction from swelling is what usually brings this disorder to the attention of rheumatic specialists. Chronic episodes of facial or extremity swelling, or purpura to the lower legs, are often ignored by the patient, and resolve spontaneously. Medical doctors too often recommend avoidance of potential foods that may stimulate an allergic reaction, resulting in difficult nutrition and anxiety disorder.

Polymyositis, Dermatomyositis, and Inclusion Body Myositis are related autoimmune disorders seen with increasing frequency in recent years. These poorly understood and complex disorders are highly associated with other autoimmune disorders such as Lupus, scleroderma, and rheumatoid arthritis, and involve both humoral immune responses (antibodies produced by B cells) and a cell-mediated complement immune response (T cell mediated). Theories of Th1/Th2 imbalance and a neurohormonal immune missense are applicable in many cases. Antibodies are found in a high percentage of patients but are varied and non-specific for myositis, often associated with other autoiummune disorders. Cytokines most associated include IL-1 alpha, IL-1 beta, and TGF beat 1-3, derived from T cells. A high percentage of cases reveal viral infection with various Cocksackie B viral strains. It is believed by many experts that these autoimmune muscle diseases often progress slowly and go undiagnosed, especially in the older population. Muscle weakness and wasting (dystrophy), discolored skin, lung inflammation, and overload of the kidneys are often the signs that lead to diagnosis. Muscle weakness usually starts in the proximal muscles of the limbs, and manifests as slowly increasing difficulties climbing stairs, rising from a seat, reaching overhead, and lifting objects. Shortness of breath, difficulty swallowing, arthritis, and arrythmias are often noticed. Calcium deposition in the muscles and skin is often seen, and may be related both to manifestation and causative factors. These are considered highly related to collagen-vascular diseases. There is no cure known, and the Cleveland Clinic recommends a comprehensive treatment strategy, with physiotherapies, heat therapies, medication and rest. The comprehensive treatments provided by many Licensed Acupuncturists may provide such approaches and complement the standard treatment well. Since standard pharmaceutical treatment involves harsh drugs, such as corticosteroids and immunosuppressants, Complementary Medicine may help to alleviate side effects as well.

Sjogren’s Syndrome is becoming one of the most prevalent autoimmune disorders seen in the population of the United States in the last decade. Some rheumatologists have classified Sjogren&dsquo;s disorder and myositis as variants of Lupus, an autoimmune disorder with a long history and a broad array of clinical manifestations. Sjogren’s disorder, or syndrome of dysfunction, was formerly called Sjogren’s Disease, until the high occurrence prompted enough research to reveal that this disorder is actually a syndrome of dysfunctions, not a specific set of symptoms defined by a single disease mechanism. Sjogren’s Syndrome is a chronic autoimmune disorder manifesting most often as dry eyes and other membranes, and affecting our blood vessels, gastrointestinal system, central nervous system, liver, kidneys, lungs and pancreas. Over 400,000 Americans have been diagnosed with Sjogren’s Syndrome, and many experts believe that the majority of sufferers have not been diagnosed. This syndrome affects predominantly women, with 9 of 10 diagnosed cases seen in females, implying a neurohormonal immune dysfunction. Over half of the diagnosed cases are secondary to other autoimmune disesases, particularly rheumatoid arthritis, lupus, or scleroderma. While the patient and their doctor often focuses on the dry eye syndrome, all cases of Sjogren’s Syndrome are systemic, and a persistent and comprehensive approach to therapy is needed. Symptoms often go into remission and reemerge during times of increases stress as the immune system health waxes and wanes. Standard therapy uses artificial tears, anti-inflammatory drugs, and sometimes surgical procedures to improve the symptoms of the dry eyes and mouth, but these do not affect the underlying problems. A growing number of in vivo studies, and human clinical trials, with randomized studies of acupuncture and herbal medicines compared to standard therapy, have demonstrated proof of the effectiveness of these therapies. These therapies in Complementary Medicine are not an alternative to standard therapy, but do provide a variety of treatment protocols that not only improve symptoms but get at the underlying health problems. A knowledgeable professional should be utilized to provide this care and insure that quality herbal medicinals are used, with utilization of nutrient medicines to improve lacrimal content, antioxidant effects, and bioavailability of chemicals for optimum immune function. So far, therapy with synthetic hormones has not been proven effective. Reestablishing a balance between the T-helper cell 1 and 2 functions (Th1/Th2) is the focus of much of the current research. The diagnosis of Sjogren’s includes a histological and serotological analysis of the contents and structure of the lacrimal and salivary glands. Histopathological findings reveal that there is a great similarity in lymphocytic infiltration and degeneration of the parenchyma (organ tissue) between Sjogren’s Syndrome and chronic autoimmune thyroiditis syndromes. Thyroiditis-related antibodies were found in 20-35% of salivary and lacrimal tissues and fluids, and approximately 30 percent of confirmed cases of Sjogren’s Syndrome presented chronic thyroiditis as a complication (PMID: 2754526). Sytemic production of autoimmune antibodies to peptides of RNA and DNA, SS-ARo and SS-B/La, is seen, as well as a variety of autoantibodies and cytokines that serve as diagnostic markers. As these autoimmune processes slowly progress, the mucosal surfaces become sites of chronic inflammation that stimulate autoimmune progression. Early treatment intervention is important.

Information Resources

An article in Clinical and Experimental Immunology, Journal of Translational Immunology, from a study of TPO antibodies in Hashimoto's thyroiditis and healthy subjects, from the Chiba University School of Medicine in Japan in 2008, found autoimmune thyroid antibodies in healthy subjects that did not trigger a typical response. The actual triggers or causes of autoimmune disorders are multifactorial and require a holistic protocol in treatment: http://www3.interscience.wiley.com/journal/119342300/abstract?CRETRY=1&SRETRY=0
A 2008 study by the National Insitute of Mental Health, National Institute of Medicine (NIH), Rockville, Maryland, shows how progesterone and cortisol both play essential roles in autoimmune disorder, with dysregulation of these hormones causing a complex feedback disorder involving the adrenal-pituitary axis, the autonomic nervous system, and the CNS-immune cytokine responses: http://www.jleukbio.org/content/84/4/924.full
A 2011 study at Semmelweis University in Budapest, Hungary, noted the association of celiac disease with angioedema; one of many studies showing a high rate of association between autoimmune disorders and celiac disease, a hypersensitivity immune disorder stemming from gluten intolerance: http://www.ncbi.nlm.nih.gov/pubmed/21304317
A 2010 review of Sjogren’s Syndrome by the Clinic for Immunology and Rheumatology in Hannover, Germany, revealed that a large percentage of patients with Sjogren’s Syndrome do not complain of the common symptoms of dry eyes and mouth due to the slow and insidious onset of the disease, and that diagnostic testing with Schirmers and Saxon tests, and salivary and lacrimal gland biopsy analyzing autoimmune antibodies to Ro (SS-A) and La (SS-B) should be more routinely administered when a dry eye, or sicca, syndrome is suspected: http:/www.ncbi.nlm.nih.gov/pubmed/20012975
A 2006 study at Zhejiang University in Hangzhou, China, revealed that a common professional Chinese herbal formula, Yiqi Yangyin Quyu, could improve clinical curative rates and regulate immune function in Sjogren’s Syndrome patients, affecting antibody and cytokine levels. : http://www.ncbi.nlm.nih.gov/pubmed/16688999
A 2010 systematic meta-review of randomized controlled clinical human trials of Chinese herbal medicine in the treatment of Sjogren’s Syndrome by the Beijing University of Chinese Medicine revealed that evidence supports Chinese Herbal Medcine to treat this autoimmune syndrome: http://www.jcimjournal.com/en/FullText2.aspx?articleID=jcim20110306
A 2009 study of the effects of electroacupuncture on the immune system, specifically the balance of Th1 and Th2 responses that are important in autoimmune pathology, showed significant benefits: http://www.ncbi.nlm.nih.gov/pubmed/19843806
A 2004 study of the effects of electroacupuncture on the immune system, specifically the balance of Th1 and Th2 responses that are important in autoimmune pathology, showed that electroacupuncture at a single point could decrease the level of IgE in circulation by suppression of the Th2 cytokines IL-4, IL-13, and other immune cells: http://www.ncbi.nlm.nih.gov/pubmed/15145602
A 2011 study showed that electroacupuncture could effectively lower the circulating levels of the inflammatory cytokine TNF-alpha and VEGF (vascular endothelial growth factor) that are highly associated with a number of autoimmune diseases, including rheumatoid arthritis: http://www.ncbi.nlm.nih.gov/pubmed/21725875
A 2010 study showed that electroacupuncture could effectively inhibit specific T-cell proliferation and help rebuild the CD4 T-cell subset balance, restoring the Th1/Th2/Th17/Treg Th cell subset balances by stimulating the hypothalamus to increase ACTH secretion: http://www.ncbi.nlm.nih.gov/pubmed?term=20117842
A 2011 study showed that electroacupuncture could effectively recruit mast cells in local tissues as a response to electroacupuncture, and that stem cell factor is involved in this recruitment of mast cells in local tissues stimulated by acupuncture points. Research has confirmed not only the local effects, but systemic effects that affect the immune responses and modulations in autoimmune disorders: http://www.ncbi.nlm.nih.gov/pubmed/21942176

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.