Senior Living: What are auto-immune diseases and how do we fight them

They are active, destructive processes. A disordered immune system attacks its victim’s tissues, causing inflammation that gradually ages and destroys them.


By Dr. Thomas LaGrelius

Contributing writer

Do you ever feel like you are at war with yourself? That’s what happens when you are unlucky enough to be struck by an auto-immune disorder.

Dr. Thomas W. LaGrelius

Auto-immune diseases include Ulcerative Colitis, Crohn’s disease, Thyroiditis, Rheumatoid Arthritis and others. They are similar in many ways and often overlap. They are active, destructive processes. A disordered immune system attacks its victim’s tissues, causing inflammation that gradually ages and destroys them.

Rheumatoid Arthritis (RA for short) is the most common and is therefore often used as an example of the class. In America, 1 to 2 percent of folks have RA, so odds are you know someone — or are someone — with it. Others are less common: About one in 1,000 Americans, for example, live with inflammatory bowel problems like Ulcerative Colitis and Crohn’s disease. Onset can be anywhere from 15-to-80 years old.

I have personal connections with RA. My grandmother, stepmother and my wife’s mother all had severe cases. One of my early childhood memories was playing board games with grandma Ethyl, because that was about all she could do. The treatment of her RA was primitive. She was in a wheelchair by age 55 and had many complications.

It is now possible to aggressively treat auto-immune diseases, including RA, preventing that scenario.

All disorders in the class are generalized diseases. Complications include anemia, heart disease, lung disease and infections. Thus, the life expectancy of auto-immune disease patients may be reduced by 10-to-15 years.

The exact cause is unknown, but this explanation is close: Most victims are genetically predisposed. Variations in at least one gene (PTPN22, in the case of RA) have been discovered. We think that in these predisposed patients, a random infection triggers the disorder.

When you become infected with anything, say a flu virus, the immune system discovers this foreign piece of DNA or RNA by its microscopic surface shape because it doesn’t look like “you.” After a few days, it makes immune cells (plasmacytes) that produce proteins (globulins) that can bond to the virus or bacteria by its shape — like a hand in a glove. This hand-in-glove complex of infecting agent and globulin attracts killer cells that secrete other really nasty chemicals. These can destroy or contain the infecting agent, perhaps saving your life.

Here is the problem: We think a microscopic surface shape somewhere in one or more of the victim’s organs closely resembles the surface on some infecting agent recently attacked by the immune system. The infection is gone or contained, so these protein globulins have little left to do, but are still looking around for that infecting organism. Unfortunately, these globulins find instead a similar microscopic surface that looks like the virus and attack it in error. The victim is in a war zone and gets hit by “friendly fire” meant for the real enemy because his cells are accidentally dressed in the wrong uniform. Our job is to selectively stop this rogue army of out of control soldier antibodies.

In the past, all we had were “anti-inflammation” drugs, such as aspirin. My grandmother took 15-to-20 aspirins a day. That helped her symptoms some, but did not stop joint and other organ destruction. Better drugs did come along. These include:


This drug, still in use, is the safest, but weakest disease-modifying drug. It suppresses the immune system a little and is somewhat selective for RA. It’s inexpensive and has few side effects, but lacks real power.


A mainstay of modern therapy until the 2000s was methotrexate. It too is still used for RA and other auto-immune diseases. It limits immune cell production by interfering with their use of a B vitamin (folic acid). However, it has a long list of troublesome side effects.

Anti-tumor necrosis factor (TNF) drugs, modern “biological” miracles

The first “biological” to come on the market to fight auto-immune disorders was Infliximab, or Remicaid, which came out in 1998. There are now many similar drugs. Though expensive, they are revolutionary and work well on many auto-immune diseases, sometimes stopping them in their tracks. These drugs are antibodies themselves, protein soldiers designed to fight the bad protein soldiers on a cellular battle field. The drugs carry serious risks, but are also complete game changers. They can prevent much of the damage done by most auto-immune diseases including RA. If you have any auto-immune disorder, ask about them — and ask early!

Live long, be well.

Dr. Thomas W. LaGrelius, M.D., F.A.A.F.P., is a certified specialist in family medicine and geriatric medicine. He is the founder and president of Skypark Preferred Family Care, a concierge primary care/geriatrics practice based in Torrance He is a staff member at Torrance Memorial Medical Center and Providence Little Company of Mary Torrance Hospital.  Email questions and topic suggestions to or call 310-378-6208.


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