--A commentary prepared by T. Stephen Balch, M.D., Member, AARDA Board of Directors; and Medical Director, Lupus Treatment Center, the Center for Specialty Medicine, Atlanta, Georgia
It is very difficult for patients with autoimmune disease to allow their doctors to obtain the proper information and diagnosis when dealing with this disorder. There are multiple reasons for this, including the fact that most doctors are not aware of autoimmunity as a disease. It is very much like high blood pressure that precedes a stroke or high cholesterol that precedes heart disease. Autoimmunity is an abnormality which does not have appropriate laboratory or physical signs that might confirm the diagnosis. To further confuse the situation, in many cases the illness has been termed "fibromyalgia" because the physicians do not have appropriate information to identify the symptoms as an autoimmune disease.
What does a physician do to arrive at a diagnosis? There are basically three components to a physician's examination: (1) the history, in which the patient gives the physician a record of what has happened to him/her previously; (2) the physical examination, by which the physician examines the patient; (3) the laboratory, which can involve, for example, blood tests, x-rays, urinalysis, and electrocardiogram. However, the problem with autoimmunity is that a patient can have a normal physical examination and laboratory analysis and yet have an autoimmune disorder.
In almost every case, it is only physicians who have had a great deal of experience with this disorder who can detect it. The most common mistaken diagnoses are that (1) the patient has a mental disorder, such as anxiety, that is creating the problems; or (2) this is fibromyalgia, which is a very nondescript term applied to a group of patients with primarily a muscular disorder. AARDA recognizes that these two very common diagnoses often are utilized to describe patients who actually have an autoimmune disorder. Using the components listed in this article (history, physical, laboratory), plus such tests as an MRI of the brain, doctors can determine whether a patient has an autoimmune disorder rather than anxiety or fibromyalgia.
The American Autoimmune Related Diseases Association (AARDA), in collaboration with a number of top-level physicians across the country, is working to develop criteria for this disorder that, according to the National Institutes of Health, is known to affect as many as 24 million patients. The set of criteria could be used by doctors to detect appropriately this very common condition, autoimmunity. We expect to have these criteria ready within the next one to two years. Obviously, this will be the most important factor in terms of determining whether someone has an autoimmune disease.
Once the set of criteria has been developed and approved, patients and doctors will have a valuable tool to expand the ability for appropriately diagnosing--and treating--autoimmune disorders. Together, AARDA and a select group of physicians, are working toward that goal.
