Achieving Remission
The Goal of Treatment in Autoimmune Diseases and Chronic Disorders
Remission, either permanent or temporary, refers to the absence of active disease in patients with chronic disorders.
Autoimmune diseases have a tendency to cause symptoms that wax and wane. Frequently patients experience periodic episodes in which there are symptoms, which alternate with periods of remission. This is especially true in the early stages of autoimmune diseases, and it can interfere with diagnosis. For instance, tests for SSa and SSb antibodies may be positive in patients with Sjogren’s disease during flares and exacerbations and these results can be negative when patients are in remission. For this reason, it can take several years before some autoimmune disorders are properly diagnosed.
What is Remission?
Remission is defined as freedom from or absence of active disease in patients with chronic medical conditions, particularly conditions of autoimmune disease and cancer. Remission does not imply that the disease is cured. Although the disease is no longer active during periods of remission, there is a possibility that it could become active again at a later time.
The goal in treating autoimmune disorders is to help patients achieve permanent remission. In patients with Graves’ disease, anti-thyroid drugs mildly suppress the immune system and they block absorption of iodine. These effects help reduce thyroid antibody production by slowing immune system activity and limiting the amount of iodine available to produce thyroid hormone. Patients with Graves’ disease achieve remission when their immune system stops producing the thyroid stimulating immunoglobulins (TSI) that cause hyperthyroidism in Graves’ disease.
Disease Courses
Many medical conditions have rather predictable disease courses. For instance, in multiple sclerosis, most patients develop a relapsing remitting disease in which episodes of symptoms occur infrequently at the onset. Over time, these episodes may become more common and patients are then classified as having a progressive form of MS. On the other hand, patients with MS may appear to spontaneously recover in which case symptoms related to neuronal damage may improve over time and no further episodes or exacerbations of symptoms may occur. In this case, the patient would be described as having benign MS or MS that’s in remission.
In the early stages of Graves’ disease, for instance, patients typically have alternating periods of symptoms and periods of remission. These symptoms can change in their degree of severity over time, and the predominant symptoms can change. In about 1/3 of patients with Graves’ disease symptoms spontaneously resolve and patients may remain in remission permanently or for many years. Other patients may continue to have periodic episodes of symptoms and over time, their thyroid hormone levels can rise. When this happens, symptoms of hyperthyroidism become persistent. In Hashimoto's thyroiditis, when sufficient thyroid cells are damaged or destroyed by inflammation, thyroid hormone levels continue to be low.
Environmental Triggers
Autoimmune diseases are caused by a combination of genetic and environmental factors. Limiting exposure to and avoiding environmental triggers are ways in which patients can help induce remission. In some autoimmune disorders such as systemic lupus erythematosus (SLE), hydrazines in mushrooms and chemicals in tobacco smoke can induce flares and exacerbations. Following dietary recommendations for systemic lupus helps reduce flares in most of the different autoimmune disorders. Allergens and stress are well known triggers of autoimmune disease. Avoiding known or suspected allergens and incorporating stress reduction techniques are also ways to reduce symptoms and help induce remission.
Remission is an achievable goal for everyone. For instance, for some patients with MS, avoiding heat while reaping the benefits of sunlight can make a big difference. For other patients with autoimmune disorders, low dose naltrexone works to stop disease progression. For patients with autoimmune thyroid disease, adding selenium, acetyl-l-carnitine or omega-3 oils can make a huge difference. For patients with SLE, rheumatoid arthritis, and other connective tissue disorders, dietary supplements recommended for lupus can reduce inflammation to a degree that harsh immunosuppressive drugs can be stopped.
However, what works for one person may not work for another. It’s important to take charge and find the therapies, lifestyle changes, and dietary solutions that work for your unique condition. Becoming empowered and involved in your own healthcare plan is one of the most important steps in achieving remission.
