This article describes the concept of remission in autoimmune disease and the factors that influence remission and trigger flares of disease activity.
Remission refers to the temporary or permanent abatement of the symptoms and signs of active disease in patients with chronic illnesses. Remission may be partial in which case most symptoms have abated, or it may be complete in which case there is a complete absence of symptoms. In autoimmune diseases such as myasthenia gravis (MG) and Graves' disease,
Remission refers to the temporary or permanent abatement of the symptoms and signs of active disease in patients with chronic illnesses. Remission may be partial in which case most symptoms have abated, or it may be complete in which case there is a complete absence of symptoms. In autoimmune diseases such as myasthenia gravis (MG) and Graves' disease, spontaneous (without the use of medications or treatment interventions or obvious medical explanation) remissions are known to occur.
In other autoimmune conditions such as autoimmune neutropenia (condition of decreased neutrophilic white blood cells), a sustained (prolonged) remission is reported to occur in a very high number of patients using specific therapies, such as intravenous Campath-1H monoclonal therapy. In some disorders such as systemic lupus erythematosus, Sjogren's syndrome, and Graves' disease, remission is accompanied by a negative or markedly reduced level of associated autoantibodies. This article describes remission in autoimmune disease and the factors influencing remission and flares.
MAINTENANCE
In some autoimmune conditions, for instance vasculitis, long-term remission can be induced and maintained in most patients with the continued use certain medications and close monitoring. In other conditions such as Graves' disease, medications are tapered after initial use, and a maintenance dose of the medication is continued until remission is achieved.
In some conditions, for instance vasculitis, immunosuppressant medications such as Imuran or Methotrexate are used to induce remission. To prevent relapse, Septra or other medications are continued as a maintenance drug therapy in patients who have moved into remission to help maintain remission.
Another example is the continued use of budesonide to prolong and maintain remission in patients with Crohn's disease, which is characterized by inflammation of the digestive tract.
FLARES
Flares are periods of heightened disease activity or a return of symptoms that interrupt periods of remission. Flares can also occur in patients who are not yet in remission but whose symptoms are controlled by one or more medications. In autoimmune disease, flares are suspected of occurring in response to severe infection, allergic reactions, physical stress, emotional trauma, surgery, and, in some autoimmune conditions, after exposure to environmental toxins such as sunlight in lupus, excess dietary iodine or low selenium levels in thyroid disease, and silica in scleroderma.
RELAPSES
If flares persist, a relapse or interruption of remission occurs. Relapses indicate a return of active disease. In relapses, symptoms may be milder, the same, or worse than they were before the last remission. In most cases, with prompt detection and treatment, a return to remission is possible.
INDUCING REMISSION
Treatments used to induce remission in autoimmune diseases include: 1) corticosteroids such as prednisone and prednisolone to reduce inflammation and mildly suppress the immune system; in autoimmune hepatitis, 80 percent of patients achieve remission using corticosteroids alone or in addition to the immunosuppressant azathioprine; 2) immunosuppressants such as azathioprine, cyclosporine and methotrexate 3) intravenous immunoglobulins used to reduce autoantibody levels in systemic rheumatological conditions such as systemic lupus erythematosus (SLE); 4) organ specific treatments such as methimazole or propylthiouracil to reduce thyroid hormone levels and mildly suppress the immune system in disorders of autoimmune hyperthyroidism; 5) organ or bone marrow transplants, for instance liver transplants in primary biliary cirrhosis and autoimmune hepatitis 6) antibacterial therapy, for instance in sarcoidosis bacteria are found in the phagocytic cells of the immune system and combinations of antibiotics such as minocycline and sulamethoxazole have been reported to induce remission; 7) lifestyle changes such as avoidance of sugar and saturated fats; 8) alternative medical treatments including herbal medicine, energy medicine, and dietary supplements.
Resources:
Crohn's disease remission prolonged and maintained with budesonide capsules, Medical News Today, Sep 14, 2005.
TG Marshall, Antibacterial Therapy Induces Remission in Sarcoidosis, Journal of Independent Medical Research Collaborative Publishing for the 21st Century, Oct 26, 2005.
