What Is Autoimmunity's Impact on Overall Health?
Most chronic conditions pervade multiple facets of a person's life, from work to school to sex. Autoimmunity is no exception.
Autoimmune disorders occur when the immune system mistakes benign, necessary tissues and cells in the body as harmful invaders, then attacks and destroys them. More than 100 known types of autoimmunity affect approximately 50 million Americans of various demographics.
These conditions can impact any organ, cell or tissue in the body. Many affect multiple body parts and systems simultaneously, with effects ranging from mental illness to sexual dysfunction.
An autoimmune diagnosis can be life-changing, especially as these conditions are not curable, and some worsen with time. However, it is possible to live a fulfilling, otherwise healthy life with autoimmunity. Understanding the potential challenges is the first step toward overcoming them.
How can autoimmunity impact overall health?
Autoimmune conditions originate in a specific place, usually a gland, joint or organ, but their effects can extend much further. Specifics differ depending on the particular condition, its severity and factors such as a person's environment, lifestyle and access to resources.
Many people who suffer from autoimmunity, though, find it substantially impacts their overall health. One reason is that many autoimmune conditions have widespread effects. For example, rheumatoid arthritis, if untreated, can act upon not just the joints but internal organs such as the heart and lungs, and the eyes. Lupus, best known for its characteristic skin rash, also causes joint and muscle pain, fever and kidney problems, among other issues.
Many autoimmune disorders produce symptoms that make it difficult for people to engage in health-promoting behaviors. These symptoms include:
- Restricted mobility
Research indicates lifestyle factors such as exercise and a balanced diet can substantially impact overall health, including blood pressure, heart function and mental well-being.
People with autoimmunity frequently develop multiple autoimmune conditions. About 25 percent of people with autoimmunity have more than one autoimmune condition, according to a paper published in the journal Maedica.
Some autoimmune diseases that frequently co-occur include type 1 diabetes, rheumatoid arthritis, multiple sclerosis (MS), inflammatory bowel disease (IBD) and lupus.
Autoimmune disorders can also contribute to complications, mainly if the disorders are not appropriately managed. The specifics vary depending on the condition, but some examples of complications include:
- Vision loss
- Joint damage
- Heart disease
- Kidney damage
Such complications generally arise in the advanced stages of an illness and can often be prevented with disease-modifying medications and other treatments and lifestyle changes.
Hormones and autoimmune disorders
There's a well-established link between the hormone estrogen and autoimmunity, according to Stuart D. Kaplan, M.D., the chief of rheumatology at Mount Sinai South Nassau in Oceanside, New York. It's one reason scientists think women, in whom estrogen levels are higher, are more likely to develop these conditions.
Most of the time, estrogen supports healthy immune system function, but it also stimulates the expression of genes associated with autoimmunity. Some researchers posit that evolutionarily, having an ultra-vigilant immune system may have been advantageous because it increases the chances of successful reproduction, even if it may also increase the risk of disease.
In people who have autoimmunity or are genetically predisposed to developing it, changing estrogen levels throughout the month and a lifetime often correlate with changes in disease symptoms. Many women are diagnosed during puberty, perimenopause or menopause. Others get diagnosed after giving birth, and most experience flare-ups before or during their period.
Pregnancy and autoimmune disorders
Transitional life stages, such as pregnancy and menopause, can also cause symptoms to worsen or disappear, depending on the person and their specific condition.
"What's usually said is that with most autoimmune diseases, about a third get better during pregnancy, a third get worse and a third stay the same. But it's not generally possible to predict who's going to do what," Kaplan said.
Autoimmune conditions can cause pregnancy complications as well, according to Kaplan. For example, people with antiphospholipid syndrome—an autoimmune disorder that causes abnormal blood clotting in the arteries and veins—are more likely to have late-term miscarriages.
Autoimmune conditions such as lupus are associated with a higher risk of preterm delivery, miscarriage, preeclampsia and intrauterine growth restriction. For this reason, pregnant people with autoimmunity are almost always considered high-risk, regardless of their condition, and require special care.
Several autoimmune conditions can make it difficult to conceive. Hashimoto's thyroiditis and type 1 diabetes, for example, cause hormonal deficiencies that disrupt ovulation and contribute to infertility, among other problems. These challenges are most prominent in people with advanced or poorly managed autoimmune conditions.
Often, treating the disease restores fertility. Such is the case with Hashimoto's.
Autoimmune disorders and mental health
Research indicates that people with chronic conditions, including autoimmune disorders, frequently experience mental health concerns such as stress, anxiety, depression and bipolar disorder.
People with preexisting mental health challenges may find these conditions get worse with the appearance of an autoimmune disease. Some people who have never experienced mental illness may encounter it for the first time.
The degree to which a physical ailment affects a person's mental health depends on the particular condition, among other factors, but there is a solid bidirectional relationship, according to Johns Hopkins Medicine. One reason for this relationship is that symptoms of autoimmunity such as pain, fatigue, mobility issues and gastrointestinal difficulties can be mentally and physically draining. They can disrupt sleep and compound exhaustion, discomfort and emotional distress.
Additionally, many people with chronic conditions feel lonely and isolated, particularly if symptoms restrict their ability to leave the house, socialize or engage in activities they enjoy.
Research indicates that certain factors are closely associated with diminished mental health. These factors include:
- Chronic pain
- Poor sleep quality
- Lack of physical activity
Autoimmunity can diminish mental health by way of inflammation, too. People with some autoimmune conditions tend to have higher levels of pro-inflammatory cytokines, such as IL-6 (interleukin), in their bloodstream, explained Jill Carnahan, M.D., the medical director of Flatiron Functional Medicine in Louisville, Colorado. These chemicals contribute to widespread inflammation and can impact chemicals in the brain that impact mood and energy.
"IL-6 is well documented to contribute to depression, anxiety and insomnia," Carnahan wrote in an email interview. "Many of these inflammatory molecules from the immune system are well known to create mood disorders and symptoms such as 'brain fog,' anxiety, depression, mania or even disordered eating."
Autoimmune-related hormonal imbalances can also contribute to mental illness. People with Hashimoto's thyroiditis, for example, frequently experience depression and anxiety because of insufficient levels of thyroid hormone, a chemical that impacts mood and cognition, among other things.
Research indicates mental illnesses may increase the risk of autoimmunity, too. A 2020 study of 44,000 people with schizophrenia, bipolar disorder, autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD) or anorexia indicated they were more likely than the general population to have at least one autoimmune condition.
Other studies suggest a link between depression and autoimmunity and post-traumatic stress and autoimmunity. The reason is uncertain, but experts posit psychological stress caused by mental illness may adversely affect the immune system, increasing susceptibility to autoimmunity.
Sexual health and autoimmunity
Sexual health and autoimmunity also are closely related. The specifics vary from one individual and condition to another, but many people with autoimmunity experience some degree of sexual dysfunction. Some of the shared concerns include low libido, erectile dysfunction (ED) and difficulty orgasming.
Findings from a small 2019 study showed that 94 percent of men with Crohn's disease or ulcerative colitis experienced ED. Another 2019 study suggested that people with rheumatoid arthritis have a significantly higher risk of sexual dysfunction than the general population. Yet another 2019 study found more than 85 percent of women with lupus experienced sexual dysfunction.
Certain conditions have a more direct impact on sexual health than others. MS, for instance, can affect the nerves in the genitals and cause numbness, while Crohn's disease can cause anal pain and fistulas. Sjögren's syndrome, which affects the glands that secrete bodily fluids, can cause vaginal dryness.
Mental health challenges, such as stress, depression, anxiety and diminished self-esteem, can further decrease libido and impede sexual health. So, too, can physical symptoms, such as fatigue, pain and mobility limitations.
Managing the underlying condition often improves sexual health symptoms. Additional approaches, such as using lubricant, trying different positions and working with a sex therapist, can also help.
Autoimmune conditions are chronic. They aren't going away, but they can often be managed well enough that people can live a life that feels normal, whatever that means to them. Treatment and management are key, though, so don't ignore symptoms and don't put off talking to a healthcare professional.