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The enemy within

The enemy within
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First Published: Tue, Jun 24 2008. 12 50 AM IST

(Illustration by: Malay Karmakar / Mint)
(Illustration by: Malay Karmakar / Mint)
Updated: Tue, Jun 24 2008. 12 50 AM IST
Within each of us is a unique, lethal and tireless fighter—our immune system. It keeps us safe in a potentially hostile world by sniffing out the environment, marching through our body and destroying any dangerous bacteria or virus. Yet, in some people, the guardian turns enemy—it targets the person’s own body. These people then fall prey to an autoimmune disease, and life becomes a battle for survival—from the enemy within.
More common than we think
(Illustration by: Malay Karmakar / Mint)
Such diseases can take different forms. “Systemic autoimmune diseases affect many organs of the body, for example, rheumatoid arthritis, scleroderma, SLE (systemic lupus erythematosus),” explains Arpit Jain, internal medicine specialist, Artemis Health Institute, Gurgaon. “But others attack only one organ; the most common example is autoimmune hypothyroidism.” In all cases, the genesis is the same—the body trains its antibodies against itself. If left untreated, this can even be fatal. While some of these diseases are rare, such as Sjogren’s syndrome, others—rheumatoid arthritis or hypothyroidism—are fairly widespread. “Hypothyroidism affects 3-5% of the population,” says Ambrish Mithal, senior consultant endocrinologist, Indraprastha Apollo Hospitals, New Delhi. It’s more common in women.
Causes
“No one really knows,” says S. Budhiraja, senior consultant, internal medicine, Max Healthcare, “It has a genetic component. The environment could play a role. It could be related to hormones. We simply aren’t sure.” A person with one sort of autoimmune disease is prone to another as well.
Treatment
Treatment tends to be symptomatic—disease-modifying drugs for systemic cases, and simply replacing the hormone if the disease is organ-specific. The response varies from patient to patient, with many leading perfectly normal lives as long as they take medication. Early detection enhances the chances of remission. But when the symptom is innocuous—a headache, for example—diagnosis is the biggest challenge.
Sjogren’s syndrome
“Just Delhi’s dust and pollution,” was how Vani Subramanian, a 43-year-old film-maker, initially dismissed her discomfort when her eyes started feeling dry and itchy. She duly applied eyedrops, and got on with life. Then, some time later, the normally healthy woman started getting strange joint aches. “Ah, age,” she said, dismissing it once again, not once connecting the two. It didn’t end there, though—her mouth and throat started feeling dry, so much so that she had difficulty eating, and had to keep drinking water. That was when she first began suspecting that all might not be well. Specialists found nothing wrong, and even a test for autoimmune disease came out negative. But by that time, her ankles had started swelling, she was fatigued all the time, and had difficulty seeing at night. At the end of her tether, she finally went to a GP, who connected all the individual symptoms, diagnosed her with Sjogren’s syndrome—a disease that leads to dryness in the body—and started her on medication immediately. Initially, she was stunned. “I’m clearly drug dependent for the rest of my life,” she says, “Coming to terms with that has been difficult.” Confused and frightened about possible implications she did not understand, she looked up the Internet for information, but terrible first-person accounts left her feeling even more depressed for a while. She has now learnt to cope, and is back to making films. “I didn’t want to sign on to this. But at least I’m coping. Now, with medication, I can do what I want to do,” she says.
Autoimmune hypothyroidism
Friends and family know Rashmi Barooah, a 40-year-old Bangalore-based doctor and mother of a five-year-old, as someone who simply does not know how to rest. So when she started complaining of extreme fatigue, her family got worried. A physician herself, she suspected it might be a thyroid problem, and even though she did not gain weight, another classic symptom, she got the relevant tests done. The levels of the thyroid stimulating hormone, as well as an antibody test, confirmed her fears—she had a disease called autoimmune hypothyroidism, where her immune system starts attacking the thyroid, a crucial part of the body that secretes chemicals that regulate the activity levels of all cells in the body. Since, in this case, the body attacks only one organ, the thyroid, the treatment is fairly straightforward— replace the low thyroid hormone in the body with an artificial version of it—the thyroxine pill. “Before my morning cup of coffee, I have medicine for my thyroid, then medicine for asthma,” says Barooah, who feels her asthma may also be an autoimmune symptom. She’s not really surprised. “I’m sure it’s genetic,” she says, “but I just make sure I pop my pills every morning, and my life goes on as hectic as ever. I’m glad I’ve got my energy back now.”
Multiple sclerosis
As a writer, Delhi-based U. Sujata, 39, works hunched over her computer all day. So, she knew what to blame when her eyes and back started hurting two years ago—or so she thought. She was shocked, however, when she closed one eye while washing her face one morning and found she couldn’t see at all with the other eye. Doctors found nothing wrong, much to her consternation. Finally, her aunt suggested she see a neurosurgeon, who concluded that it was probably multiple sclerosis, an autoimmune disease that attacks the nerves of the body, so that the function of different body parts controlled by those nerves is affected. It is neither curable nor reversible. An MRI scan was done; she was hospitalized, and put on steroids, and got better. A year later, when she was flying back after a holiday in the UK, her legs started tingling and one foot felt colder than the other. Only then did doctors confirm the diagnosis. “I felt terrible, so out of control, initially,” she says, “the unpredictability is unnerving, you just don’t know when it will strike.” But she came out of every relapse and that gave her courage. “Every time I do a task now, if I can manage to complete it, I feel blessed and grateful,” she says.
Rheumatoid arthritis
Chennai-based A.K. Chari, a 60-plus former executive, liked to believe that one is as young as one feels, and looked forward to an active life after retirement, pursuing his various interests. A few months ago, however, he experienced what is often considered a classic symptom of age—pain in the joints, which grew so bad that he couldn’t climb up the stairs to his house. Then his wrists started hurting, and finally his shoulder joints, which felt like they were frozen. In agony, he consulted a doctor. Tests and X-rays confirmed that he had rheumatoid arthritis, an autoimmune disease where the immune system attacks the body’s joints, causing inflammation. In some cases, it can even attack organs such as the lungs and heart. Like other autoimmune diseases, there is no cure, but Chari was given painkillers and steroids to alleviate the symptoms. “I’m feeling better with the medicines, but it is still painful,” he says. He also goes for regular physiotherapy. “I’ve read up on the disease, and I know it can be progressive, and that exercise can help,” he says. A lifetime of stoicism and discipline now stands him in good stead. Without fail, he goes for a half-hour walk every day.
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First Published: Tue, Jun 24 2008. 12 50 AM IST