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Publication Date January 2002

Questions and Answers About Autoimmunity

This booklet answers questions about autoimmunity. To learn more

about autoimmunity, your immune system, or autoimmune diseases,

speak with your doctor. You can also check out the Appendices below.

What Is Autoimmunity?

What Causes Autoimmunity?

What Kinds of Problems Are Caused by Autoimmunity?

How Are Autoimmune Diseases Diagnosed?

How Are Autoimmune Diseases Treated?

What Types of Doctors Treat Autoimmune Diseases?

What Are Some Other Problems Related to Autoimmune Diseases?

What Research Is Being Conducted To Help People With Autoimmune

Diseases?

Where Can People Find More Information About Autoimmunity?

Appendix I: Glossary of Terms

Appendix II: Glossary of Diseases

What Is Automimmunity?

When your body is attacked--perhaps by a virus or germs on a nail

you stepped on--your immune system defends you. It sees and kills

the germs that might hurt you.

But when the system doesn't work right, this process can cause harm.

Immune cells can mistake your body's own cells as invaders and

attack them. This " friendly fire " can affect almost any part of the

body. It can sometimes affect many parts of the body at once. This

is called autoimmunity (meaning self-immunity).

What Causes Autoimmunity?

No one knows why the immune system treats some body parts like

germs. We do know that you can't catch autoimmune diseases from

another person.

Most scientists think that our genes and things in the environment

are involved. If you have a certain gene or combination of genes,

you may be at higher risk for autoimmune disease. But you won't get

the disease until something around you turns on your immune system.

This may include the sun, infections, drugs, or, in some women,

pregnancy.

What Kinds of Problems Are Caused by Autoimmunity?

Autoimmunity can affect almost any organ or body system. The exact

problem one has with autoimmunity (or its diseases) depends on which

tissues are targeted.

If the skin is the target, you may have skin rashes, blisters, or

color changes. If it's the thyroid gland, you may be tired, gain

weight, be more sensitive to cold, and have muscle aches. If it's

the joints, you may have joint pain, stiffness, and loss of function.

You may know which organ or system is affected from the start. But

you may not know the site of the attack. In many people, the first

symptoms are fatigue, muscle aches, and low fever.

Where Does Autoimmunity Strike?

Because autoimmune diseases can affect almost any organ or system of

the body, one way to group them is by the body system(s) they

attack. The following is a list (not inclusive) of body systems and

the autoimmune diseases that can affect them.

Blood and blood vessels

Autoimmune hemolytic anemia

Pernicious anemia

Polyarteritis nodosa

Systemic lupus erythematosus

Wegener's granulomatosis

Digestive tract (including the mouth)

Autoimmune hepatitis

Behçet's disease

Crohn's disease

Primary bilary cirrhosis

Scleroderma

Ulcerative colitis

Eyes

Sjögren's syndrome

Type 1 diabetes mellitus

Uveitis

Glands

Graves' disease

Thyroiditis

Type 1 diabetes mellitus

Heart

Myocarditis

Rheumatic fever

Scleroderma

Systemic lupus erythematosus

Joints

Ankylosing spondylitis

Rheumatoid arthritis

Systemic lupus erythematosus

Kidneys

Glomerulonephritis

Systemic lupus erythematosus

Type 1 diabetes mellitus

Lungs

Rheumatoid arthritis

Sarcoidosis

Scleroderma

Systemic lupus erythematosus

Muscles

Dermatomyositis

Myasthenia gravis

Polymyositis

Nerves and brain

Guillain-Barré syndrome

Multiple sclerosis

Systemic lupus erythematosus

Skin

Alopecia areata

Pemphigus/pemphigoid

Psoriasis

Scleroderma

Systemic lupus erythematosus

Vitiligo

How Are Autoimmune Diseases Diagnosed?

Autoimmune diseases often don't show a clear pattern of symptoms at

first. So diagnosing them can be hard. But with time, a diagnosis

can usually be made by using:

Medical history--The doctor will ask about your symptoms and how

long you have had them. Your symptoms may not point to one disease.

But they can be a starting point for your doctor. You should tell

your doctor if you have a family member with autoimmune disease. You

may not have the same disease as your family member. But having a

family history of any autoimmune disease makes you more likely to

have one.

Physical exam--During the exam, the doctor will check for any signs.

Inflamed joints, swollen lymph nodes, or discolored skin might give

clues.

Medical tests--No one test will show that you have an autoimmune

disease. But doctors may find clues in a blood sample. For example,

people with lupus or rheumatoid arthritis often have certain

autoantibodies in their blood. Autoantibodies are blood proteins

formed against the body's own parts.

Not all people with these diseases have these autoantibodies. And

some people without autoimmune disease do have them. So blood tests

alone may not always help. But if a person has disease symptoms and

autoantibodies, the doctor can be more sure of a diagnosis.

The key is patience. Your doctor may be able to diagnose your

condition quickly based on your history, exam, and test results. But

the process often takes time. It may take several visits to find out

exactly what's wrong and the best way to treat it.

How Are Autoimmune Diseases Treated?

Autoimmunity takes many forms. There are also many treatments for

it. Treatment depends on the type of disease, how severe it is, and

its symptoms. Generally, treatments have one of three goals:

Relieving symptoms--If your symptoms bother you, your doctor may

suggest treatments that give some relief. Relieving symptoms may be

as simple as taking a drug for pain relief. It may also be as

involved as having surgery.

Preserving organ function--When autoimmune diseases threaten organs,

treatment may be needed to prevent damage. Such treatments may

include drugs to control an inflamed kidney in people with lupus.

Insulin injections can regulate blood sugar in people with diabetes.

These treatments don't stop the disease. But they can save organ

function. They can also help people live with disease complications.

Targeting disease mechanisms--Some drugs may also be used to target

how the disease works. In other words, they can suppress the immune

system. These drugs include cyclophosphamide (Cytoxan*) and

cyclosporine (Neoral and Sandimmune). The same immune-suppressing

drug may be used for many diseases.

Your doctor may not prescribe a treatment. If your symptoms are

mild, the risks of treatment may be worse than the symptoms. You may

choose to put off treatment for now. But you should watch for signs

that your disease is progressing. Visit your doctor regularly. You

need to catch changes before they lead to serious damage.

*Brand names included in this booklet are provided as examples only,

and their inclusion does not mean that these products are endorsed

by the National Institutes of Health or any other Government agency.

Also, if a particular brand name is not mentioned, this does not

mean or imply that the product is unsatisfactory.

What Types of Doctors Treat Autoimmune Diseases?

Treatments for autoimmune diseases vary. So do the types of doctors

who provide them.

For some people, one doctor will be enough to manage their disease.

Others may require a team approach. One doctor might coordinate and

give care, and others would treat specific organ problems. For

example, a person with lupus might be seen by a rheumatologist. But

that person might also see a nephrologist for related kidney

problems and a dermatologist for skin problems.

Specialists you may need to see include:

A rheumatologist, who treats arthritis and other rheumatic diseases.

These include scleroderma and systemic lupus erythematosus (lupus or

SLE).

An endocrinologist, who treats gland and hormone problems. These

include diabetes and thyroid disease.

A neurologist, who treats nerve problems. These include multiple

sclerosis and myasthenia gravis.

A hematologist, who treats diseases that affect the blood. These

include pernicious anemia and autoimmune hemolytic anemia.

A gastroenterologist, who treats problems with the digestive system.

These include Crohn's disease and ulcerative colitis.

A dermatologist, who treats problems of the skin, hair, and nails.

These include psoriasis, pemphigus/pemphigoid, and alopecia areata.

A nephrologist, who treats kidney problems. These include

glomerulonephritis, inflamed kidneys associated with lupus.

What Are Some Other Problems Related to Autoimmune Diseases?

Having a chronic disease can affect almost every part of your life.

The problems you might have with an autoimmune disease vary. They

may include:

How you look and your self-esteem--Depending on your disease, you

may have discolored or damaged skin or hair loss. Your joints may

look different. These can all affect how you look and your self-

esteem. Such problems can't always be prevented. But their effects

can be reduced with treatment. Cosmetics, for example, can hide a

skin rash. Surgery can correct a malformed joint.

Caring for yourself--Painful joints or weak muscles can make it hard

to do simple tasks. You may have trouble climbing stairs, making

your bed, or brushing your hair. If doing daily tasks is hard, talk

with a physical therapist. The therapist can teach you exercises to

improve strength and function. An occupational therapist can show

you new ways to do things or tools to make tasks easier. Sometimes

regular exercise or simple devices can help you do more things on

your own.

Family relationships--Family members may not understand why you

don't have energy to do things you used to do. They may even think

you are just being lazy. But they may also be overly concerned and

eager to help you. They may not let you do the things you can do.

They may even give up their own interests to be with you. Learn as

much as you can about your disease. Share what you learn with your

family. Involve them in counseling or a support group. It may help

them better understand the disease and how they can help.

Sexual relations--Sexual relationships can also be affected. For

men, diseases that affect blood vessels can lead to problems with

erection. In women, damage to glands that produce moisture can lead

to vaginal dryness. This makes intercourse painful. In both men and

women, pain, weakness, or stiff joints may make it hard for them to

move the way they once did. They may not be sure about how they

look. Or they may be afraid that their partner will no longer find

them attractive. With communication, good medical care, and perhaps

counseling, many of these issues can be overcome or at least worked

around.

Pregnancy and childbearing--In the past, women with some autoimmune

diseases were told not to have children. But better treatments and

understanding have changed that advice. Autoimmune diseases can

affect pregnancy, and pregnancy can affect autoimmune diseases. But

women with many such diseases can safely have children. How a

pregnancy turns out can vary by disease and disease severity. If you

have an autoimmune disease, you should consult your doctor about

having children.

What Research Is Being Conducted To Help People With Autoimmune

Diseases?

The National Institutes of Health (NIH) supports research in

autoimmune diseases. Here are a few examples:

Rheumatoid arthritis--The National Institute of Arthritis and

Musculoskeletal and Skin Diseases (NIAMS) and the North American

Rheumatoid Arthritis Consortium will study 1,000 siblings with

rheumatoid arthritis. Scientists will look at gene material to find

and identify parts of DNA involved in the disease. They will test

for proteins called rheumatoid factor in the blood. And they will

look at x rays of the joints. This work will provide basic facts

about the genetics of the disease.

Systemic lupus erythematosus (SLE)--NIAMS-supported scientists are

studying whether women with lupus can safely take oral

contraceptives or hormone replacement therapy. Previous research

suggests that female hormones may contribute to the disease or make

it worse.

Lupus nephritis--One NIAMS project is testing a drug that may be

less toxic than the drugs now used for lupus nephritis (kidney

disease caused by lupus).

Vitiligo--With NIAMS support, scientists are studying genes from

pairs of siblings affected by this skin pigmentation disorder. They

hope to find genes that may cause vitiligo and learn how they affect

the skin.

Type 1 diabetes--Researchers supported by the National Institute of

Diabetes and Digestive and Kidney Diseases have found a way to

identify people who are likely to get type 1 diabetes (formerly

known as juvenile diabetes). They are now testing ways to prevent

these people from getting the disease.

Multiple sclerosis--Scientists supported by the National Institute

of Neurological Disorders and Stroke are looking at the autoimmune

system, infectious agents, and genes as culprits in multiple

sclerosis (MS). Such studies strengthen the theory that MS comes

from a number of factors rather than a single one. Studies use

magnetic resonance imaging to see how MS lesions evolve in the

brain's white matter. Research has shown that MS has no bad effects

on pregnancy, labor, or delivery. In fact, the stabilizing or

remission of symptoms during pregnancy may be due to changes in a

woman's immune system that allow her to carry a baby.

Multiple autoimmune diseases--The National Institute of Allergy and

Infectious Diseases is supporting clinical trials of drugs that

prevent the immune system from attacking healthy cells. The

Institute wants to see if they are safe and useful. Such drugs may

prove helpful for treating a number of autoimmune diseases.

Where Can People Find More Information About Autoimmunity?

Various parts of the NIH provide information on different aspects of

autoimmune diseases. Many nonprofit organizations have patient

resources, local chapters, and support groups. Your own doctor can

best tell you about your own medical condition.

National Institutes of Health

National Institute of Arthritis and Musculoskeletal and Skin

Diseases (NIAMS)

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484 or 877-22-NIAMS (226-4267) (free of charge)

TTY: 301-565-2966

Fax: 301-718-6366

www.niams.nih.gov

National Institute of Allergy and Infectious Diseases

Office of Communications

Building 31, Room 7A50

31 Center Drive, MSC 2520

Bethesda, MD 20892-2520

Phone: 301-496-5717

www.niaid.nih.gov/publications

and

www.niaid.nih.gov/clintrials/default.htm (for clinical trials

information)

National Institute of Diabetes and Digestive and Kidney Diseases

(NIDDK)

National Diabetes Information Clearinghouse (NDIC)

1 Information Way

Bethesda, MD 20892-3560

Phone: 301-654-3327 or 800-860-8747 (free of charge)

Email: ndic@...

www.niddk.nih.gov

National Institute of Neurological Disorders and Stroke

Office of Scientific and Health Reports

P.O. Box 5801

Bethesda, MD 20824

Phone: 301-496-5751 or 800-352-9424 (free of charge)

www.ninds.nih.gov

NIH Clinical Center

Patient Recruitment and Public Liaison--for specific

NIH clinical trials information

Building 60

10 Cloister Court

Bethesda, MD 20892-4754

Phone: 800-411-1222 (free of charge)

TTY: 866-411-1010

E-mail: prpl@...

http://clinicalstudies.info.nih.gov/referring_patient.html

Office of Rare Diseases

Building 31, Room 1B19

31 Center Drive

Bethesda, MD 20892

Phone: 301-402-4336

http://rarediseases.info.nih.gov

Other Resources Sponsored by the U.S. Department of Health and Human

Services

Combined Health Information Database

www.chid.nih.gov

National Health Information Center

Phone: 301-565-4167 or 800-336-4797 (free of charge)

Health Finder: www.healthfinder.gov

Other Organizations

American Academy of Orthopaedic Surgeons

P.O. Box 2058

Des Plaines, IL 60017

Phone: 800-824-BONE (2663) (free of charge)

www.aaos.org

American College of Rheumatology

1800 Century Place, Suite 250

Atlanta, GA 30345

Phone: 404-633-3777

Fax: 404-633-1870

E-mail: acr@...

www.rheumatology.org

American Autoimmune Related Diseases Association

22100 Gratiot Avenue

Eastpointe, MI 48201-2227

Literature requests: 800-598-4668 (free of charge)

Phone: 586-776-3900

Fax: 586-776-3903

E-mail: aarda@...

www.aarda.org

American Behçet's Disease Association

P.O. Box 15247

Chattanooga, TN 37415-0240

Phone: 800-7-BEHCET (723-4238) (free of charge)

www.behcets.com

American Diabetes Association

Attn: Customer Service

1701 N. Beauregard Street

andria, VA 22311

Phone: 800-DIABETES (342-2383) (free of charge)

www.diabetes.org

American Liver Foundation

75 Maiden Lane, Suite 603

New York, NY 10038

Phone: 973-256-2550 or 800-443-7222 (free of charge)

www.liverfoundation.org

Arthritis Foundation

1330 West Peachtree Street

Atlanta, GA 30309

Phone: 800-283-7800 (free of charge)

www.arthritis.org

Crohn's and Colitis Foundation of America

National Headquarters

386 Park Avenue South, 17th Floor

New York, NY 10016-8804

Phone: 800-932-2423 (free of charge)

800-343-3637 (Warehouse)

www.ccfa.org

Guillain-Barré Syndrome Foundation International

P.O. Box 262

Wynnewood, PA 19096

Phone: 610-667-0131

Fax: 610-667-7036

E-mail: gbint@...

www.guillain-barre.com

Juvenile Diabetes Research Foundation International

120 Wall Street

New York, NY 10005-4001

Phone: 212-785-9500 or 800-JDF-CURE (533-2873) (free of charge)

Fax: 212-785-9595

E-mail: info@...

www.jdf.org

Lupus Foundation of America, Inc. (LFA)

2000 L Street, N.W., Suite 710

Washington, DC 20036

Phone: 202-349-1155

Toll-Free: (800)558-0121

Fax: 202-349-1156

E-mail: lupusinfo@...

www.lupus.org

Myasthenia Gravis Foundation of America

5841 Cedar Lake Road, Suite 204

Minneapolis, MN 55416

Phone: 952-545-9438 or 800-541-5454 (free of charge)

Fax: 952-545-6073

E-mail: myasthenia@...

www.myasthenia.org

Myositis Association

1233 20th Street, NW, Suite 402

Washington DC 20036

Phone: 202-887-0088

Fax: 202-466-8940

E-mail: tma@...

www.myositis.org

National Adrenal Diseases Foundation

505 Northern Boulevard

Great Neck, NY 11021

Phone: 516-487-4992

E-mail: nadfmail@...

www.medhelp.org/nadf

National Alopecia Areata Foundation

14 Boulevard

San , CA 94903

or

P.O. Box 150760

San , CA 94915

Phone: 415-472-3780

Fax: 415-472-5343

www.naaf.org

National Multiple Sclerosis Society

733 Third Avenue, 6th Floor

New York, NY 10017-3288

Phone: 212-986-3240 or 800-344-4867 (free of charge)

Fax: 212-986-7981

E-mail: info@...

www.nmss.org

National Organization for Rare Diseases

55 Kenosia Avenue

P.O. box 1968

Danbury, CT 06813-1968

Phone: 203-744-0100 or 800-999-6673 (free of charge)

E-mail: orphan@...

www.rarediseases.org

International Pemphigus Foundation

1540 River Park Drive, Suite 208

Sacramento, California 95815

Phone: 916-922-1298

Fax: 916-922-1458

E-mail: pemphigus@...

www.pemphigus.org

National Psoriasis Foundation

6600 SW 92nd Avenue, Suite 300

Portland, OR 97223-7195

Phone: 503-244-7404 or 800-723-9166 (free of charge)

Fax: 503-245-0626

E-mail: getinfo@...

www.psoriasis.org

National Vitiligo Foundation

700 Olympic Plaza Circle, Suite 404

Tyler, TX 75701

Phone: (903) 595-3713

Fax: (903) 593-1545

E-mail: info@...

www.nvfi.org/index.html

Scleroderma Foundation

300 Rosewood Drive, Suite 105

Danvers, MA 01923

Phone 978-463-5843

Toll-free: 800-722-HOPE (4673)

Fax: 978-463-5809

Email: sfinfo@...

www.scleroderma.org/

Scleroderma Research Foundation

220 Montgomery Street, Suite 1411

San Francisco, CA 94104

Phone: 415-834-9444 or

800-441-CURE (2873) (free of charge)

Fax: 415-834-9177

E-mail: srfcure@...

www.srfcure.org

Sjögren's Syndrome Foundation

8120 Woodmont Avenue, Suite 530

Bethesda, MD 20814

Phone: 301-718-0300

or 800-4-SJOGRENS (475-6473) (free of charge)

Fax: 301-718-0322

E-mail: ssf@...

www.sjogrens.org or www.sjogrens.com

Spondylitis Association of America

P.O. Box 5872

Sherman Oaks, CA 91413

Phone: 800-777-8189 (free of charge)

E-mail: info@...

www.spondylitis.org

SLE Foundation, Inc.

149 Madison Avenue, Suite 205

New York, NY 10016

Phone: 212-685-4118

Fax: 212-545-1843

E-mail: lupus@...

www.lupusny.org

Thyroid Foundation of America, Inc.

410 Stuart Street

Boston, MA 02116

Phone: 617-534-1500 or 800-832-8321 (free of charge)

Fax: 617-534-1515

E-mail: info@...

www.allthyroid.org

Wegener's Association

P.O. Box 28660

Kansas City, MO 64188-8668

Phone: 800-277-9474 (free of charge)

Phone/Fax: 816-436-8211

E-mail: wga@...

www.wgassociation.org

Appendix I: Glossary of Terms

Antibodies--Special proteins produced by the body's immune system

that help fight and destroy viruses, bacteria, and other foreign

substances that invade the body.

Antigen--A substance (usually foreign) that stimulates the immune

response. In people with autoimmune disease, the body's own cells

may be seen as antigens.

Autoantibodies--Abnormal antibodies that attack parts of the body,

causing autoimmune disease.

Autoimmune disease--A disease that occurs when the immune system

turns against parts of the body it is designed to protect.

Fever--A rise in body temperature caused by the immune system's

response to infection or disease.

Immune response--The reaction of the immune system against foreign

substances. When the reaction occurs against the body's own cells or

tissues, it is called an autoimmune reaction.

Immune system--A complex system that normally protects the body from

infections. The immune system consists of a group of cells, the

chemicals that control those cells, and the chemicals that those

cells release.

Immunosuppressive drugs--Drugs that suppress the immune response and

can be used to treat autoimmune disease. Unfortunately, because

normal immunity is also suppressed with these drugs, they leave the

body at risk for infection.

Infection--Invasion of the body tissues by bacteria or other tiny

organisms that cause illness.

Inflammation--A reaction of tissues to injury or disease, typically

marked by four signs: swelling, redness, heat, and pain.

Trigger--Something that either sets off a disease in people who are

genetically predisposed to developing the disease, or that causes a

certain symptom to occur in a person who has a disease. For example,

sunlight can trigger rashes in people with lupus.

Appendix II: Glossary of Diseases

Autoimmunity plays a role in more than 80 diseases. Following are

brief descriptions of some of the many diseases in which

autoimmunity may be involved.

Note: Because the specific causes of many diseases are unknown,

there is debate among scientists about whether some of these are

truly autoimmune diseases. Your own doctor may classify some of

these diseases differently.

Alopecia areata--A disorder in which the immune system attacks the

hair follicles, causing loss of hair on the scalp, face, and other

parts of the body.

Ankylosing spondylitis--A rheumatic disease that causes inflamed

joints in the spine and sacroiliac (the joints that connect the

spine and the pelvis) and, in some people, inflamed eyes and heart

valves.

Arthritis--A general term for more than 100 different diseases that

affect the joints. Many forms of arthritis and related conditions

are believed to have an autoimmune component.

Autoimmune hemolytic anemia--A condition in which immune system

proteins attack the red blood cells, resulting in fewer of these

oxygen-transporting cells.

Autoimmune hepatitis--A disease in which the body's immune system

attacks liver cells, causing inflammation. If not stopped,

inflammation can lead to cirrhosis (scarring and hardening) of the

liver and eventually liver failure.

Behçet's disease--A condition characterized by sores in the mouth

and on the genitals and by inflammation in parts of the eye. In some

people, the disease also results in inflammation of the joints,

digestive tract, brain, and spinal cord.

Crohn's disease--An inflammatory disease of the small intestine or

colon that causes diarrhea, cramps, and excessive weight loss.

Dermatomyositis--A rare autoimmune disease that causes patchy red

rashes around the knuckles, eyes, and other parts of the body along

with chronic inflammation of the muscles. It may occur along with

other autoimmune diseases such as rheumatoid arthritis or systemic

lupus erythematosus.

Diabetes mellitus, type 1--A condition in which the immune system

destroys insulin-producing cells of the pancreas, making it

impossible for the body to use glucose (blood sugar) for energy.

Type 1 diabetes usually occurs in children and young adults.

Glomerulonephritis--Inflammation of the kidney's tiny filtering

units, which in severe cases can lead to kidney failure.

Graves' disease--An autoimmune disease of the thyroid gland that

results in the overproduction of thyroid hormone. This causes such

symptoms as nervousness, heat intolerance, heart palpitations, and

unexplained weight loss.

Guillain-Barré syndrome--A disorder in which the body's immune

system attacks part of the nervous system, leading to numb, weak

limbs and, in severe cases, paralysis.

Inflammatory bowel disease--The general name for diseases that cause

inflammation in the intestine, the most common of which are

ulcerative colitis and Crohn's disease.

Lupus nephritis--Damaging inflammation of the kidneys that can occur

in people with lupus. If not controlled, it may lead to total kidney

failure.

Multiple sclerosis--A disease in which the immune system attacks the

protective coating called myelin around the nerves. The damage

affects the brain and/or spinal cord and interferes with the nerve

pathways, causing muscular weakness, loss of coordination, and

visual and speech problems.

Myasthenia gravis--A disease in which the immune system attacks the

nerves and muscles in the neck, causing weakness and problems with

seeing, chewing, and/or talking.

Myocarditis--Inflamed and degenerating muscle tissue of the heart

that can cause chest pain and shortness of breath. This can lead to

congestive heart failure.

Pemphigus/pemphigoid--An autoimmune disease of the skin

characterized by itching and blisters.

Pernicious anemia--A deficiency of the oxygen-carrying red blood

cells that often occurs in people with autoimmune diseases of the

thyroid gland.

Polyarteritis nodosa--An autoimmune disease that causes inflammation

of the small and medium-sized arteries. This leads to problems in

the muscles, joints, intestines, nerves, kidney, and skin.

Polymyositis--A rare autoimmune disease characterized by inflamed

and tender muscles throughout the body, particularly those of the

shoulder and hip girdles.

Primary biliary cirrhosis--A disease that slowly destroys the bile

ducts in the liver. When the ducts are damaged, bile (a substance

that helps digest fat) builds up in the liver and damages liver

tissue.

Psoriasis--A chronic skin disease that occurs when cells in the

outer layer of the skin reproduce faster than normal and pile up on

the skin's surface. This results in scaling and inflammation. An

estimated 10 to 30 percent of people with psoriasis develop an

associated arthritis called psoriatic arthritis.

Rheumatic fever--A disease that can occur following untreated

streptococcus (strep) infection. It most often affects children,

causing painful, inflamed joints and, in some cases, permanent

damage to heart valves.

Rheumatoid arthritis--A disease in which the immune system is

believed to attack the linings of the joints. This results in joint

pain, stiffness, swelling, and destruction.

Sarcoidosis--A disease characterized by granulomas (small growths of

blood vessels, cells, and connective tissue) that can lead to

problems in the skin, lungs, eyes, joints, and muscles.

Scleroderma--An autoimmune disease characterized by abnormal growth

of connective tissue in the skin and blood vessels. In more severe

forms, connective tissue can build up in the kidneys, lungs, heart,

and gastrointestinal tract, leading in some cases to organ failure.

Sjögren's syndrome--A condition in which the immune system targets

the body's moisture-producing glands, leading to dryness of the

eyes, mouth, and other body tissues.

Systemic lupus erythematosus--An autoimmune disease, primarily of

young women, that can affect many parts of the body, including the

joints, skin, kidneys, heart, lungs, blood vessels, and brain.

Thyroiditis--An inflammation of the thyroid gland that causes the

gland to become underactive. This results in symptoms such as

fatigue, weakness, weight gain, cold intolerance, and muscle aches.

Ulcerative colitis--A disease that causes ulcers in the top layers

of the lining of the large intestine. This leads to abdominal pain

and diarrhea.

Uveitis--The inflammation of structures of the inner eye, including

the iris (the colored tissue that holds the lens of the eye) and the

choroid plexus (a network of blood vessels around the eyeball).

Uveitis occurs with some rheumatic diseases, including ankylosing

spondylitis and juvenile rheumatoid arthritis.

Vitiligo--A disorder in which the immune system destroys pigment-

making cells called melanocytes. This results in white patches of

skin on different parts of the body.

Wegener's granulomatosis--An autoimmune disease that damages the

small and medium-sized blood vessels throughout the body, resulting

in disease in the lungs, upper respiratory tract, and kidneys.

Acknowledgments

The NIAMS gratefully acknowledges the assistance of Jill Buyon,

M.D., of New York University Medical Center, New York, NY; Elaine

Collier, M.D., of the National Institute of Allergy and Infectious

Diseases, NIH; Gretz, M.D., of NIAMS, NIH; Lipsky,

M.D., of NIAMS, NIH; Lockshin, M.D., of the Hospital for

Special Surgery, New York, NY; Barbara Mittleman, M.D., of NIAMS,

NIH; Alan Moshell, M.D., of NIAMS, NIH; and Noel Rose, M.D., Ph.D.,

of the s Hopkins University School of Hygiene and Public Health,

Baltimore, MD, in the preparation and review of this booklet.

Anne Dunkin was the primary author of this booklet.

The mission of the National Institute of Arthritis and

Musculoskeletal and Skin Diseases (NIAMS), a part of the National

Institutes of Health (NIH), is to support research into the causes,

treatment, and prevention of arthritis and musculoskeletal and skin

diseases, the training of basic and clinical scientists to carry out

this research, and the dissemination of information on research

progress in these diseases. The National Institute of Arthritis and

Musculoskeletal and Skin Diseases Information Clearinghouse is a

public service sponsored by the NIAMS that provides health

information and information sources. Additional information can be

found on the NIAMS Web site at www.niams.nih.gov.

This booklet is not copyrighted. Readers are encouraged to duplicate

and distribute as many copies as needed.

Additional copies of this booklet are available from

National Institute of Arthritis and Musculoskeletal

and Skin Diseases

NIAMS/National Institutes of Health (NIH)

1 AMS Circle

Bethesda, MD 20892-3675

NIH Publication No. 02-4858

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