4 ■
FALL 1995 ISSUE ■ SINAI HOSPITAL
HealthNews
Sinai Experts Unmask The "Great Masqueraders"
I
n an autoimmune disease, a vital body
function fails. "Normally, the immune
system recognizes foreign invaders
and rids our body of them," explains
Chaim Brickman, MD, director of the
Lupus and Immunology Program and chief
of Allergy-Immunology at Sinai.
But in this group of diseases, "The im-
mune system rejects foreign invaders and
the patient him- or herself. The body's
immune system attacks any part of the
its not uncommon
•••
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for patients
in early stages
of autoimmune diseases
to be told that
they have a
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psychiatric problem."
patient and causes inflammation even
when there are no invaders. Every part of
the body may be vulnerable to an autoim-
mune attack."
Autoimmune diseases are often very dif-
ficult to diagnose, earning them the nick-
name "the great masqueraders."
In some patients they affect no specific
organ. Yet, in others they attack a single
organ or whole organ systems. Common
autoimmune diseases include type I dia-
betes, lupus, multiple sclerosis, rheuma-
toid arthritis, and thyroid problems.
Most are not acutely life threatening; if not
treated, though, they can be disabling.
In early stages of an autoimmune dis-
ease, symptoms can vary widely. Patients may
have joint or muscle pain, unexplained abnormal
blood tests or low blood counts, enlarged lymph
nodes, or no symptoms whatsoever. Non-specif-
ic complaints may include fatigue, fevers, night
sweats, hair loss, rash, and shortness of breath.
"Symptoms may cross over many different or-
gan systems. The clues are frequently so varied
and vague that it presents difficulty sorting out
which symptoms are or are not related to the dis-
ease," explains Dr. Brickman. "The most human
part of the problem," asserts Dr. Brickman, "is
that in many cases the patient looks normal.
Unlike a condition in which it's easy to see the
abnormality, patients with autoimmune illness-
es frequently say they feel horrible — but they
look wonderful."
That huge contrast in how a person looks and
feels often makes family members, and even some
physicians, doubtful of real illness. "It's not un-
common for patients in early stages of autoim-
mune diseases to be told that they have a
psychiatric problem," contends Dr. Brickman.
exposed to," he adds. "If the patient
Every part of the
"Patients begin to doubt themselves."
body may be
has the right genetic makeup or racial
In rheumatoid arthritis the joints are
vulnerable to an
background, an infection may be the
a target of attack. According to Samuel
autoimmune attack.
main trigger for development of some
Indenbaum, MD, chief of staff at Sinai,
of these diseases."
"People mistakenly associate joint pain
Scientific research has found that
with rheumatism and that it's a normal
part of aging. They don't realize how debilitat- African-American females with a family history
of autoimmune diseases have a higher risk of de-
ing it can become... and that it's treatable."
veloping lupus than the general population. "Sev-
In multiple sclerosis, it's the brain and central ner-
eral genetic markers have been identified and can
vous system that are damaged. In diabetes,
be tested for, which seem to predispose or increase
it's the pancreas, which leads to dysfunctions in
eyes, kidneys, the cardiovascular system and the risk of developing an autoimmune disease,"
Dr. Brickman says.
other areas. In lupus, it may be any organ, but
"The nice thing is that for most cases we now
most often the targets of attack are joints, skin,
have adequate or excellent medication," he re-
and kidneys.
ports. Because autoimmune diseases affect
"In most cases, we're not clear as to the cause
so many organs, so many parts of human life,
because there are probably multiple causes," Dr.
patients really need specialists who know each
Brickman states. "The common factors often in-
of those diseases well. These specialists need to
clude genetics, gender, infectious agents, and/or
work as a team to treat those conditions, the
environmental triggers.
"There are some theories that rheumatoid patients, and their families. These experts are
arthritis, lupus and perhaps diabetes might be re- available at Sinai.
lated to certain viruses or bacteria that people are