Autoimmune Disorders: Types, Symptoms and Treatment

What makes a disorder autoimmune

Your immune system is trained to ignore your own cells. This is called tolerance. In an autoimmune disorder, tolerance breaks down. The body makes autoantibodies (antibodies against its own proteins) or self-reactive T cells, and these damage a target tissue.

The damage takes one of two forms:

• Destruction: cells are killed and the organ stops working. Examples are insulin-making cells in type 1 diabetes and thyroid cells in Hashimoto's.
• Overstimulation or blocking: antibodies switch a receptor on or off. In Graves' disease they switch the thyroid on. In myasthenia gravis they block nerve signals to muscles.

No single cause has been found. Most disorders need a combination of genes (especially certain HLA immune genes), hormones, and a trigger such as an infection, smoking, certain medicines or ultraviolet light. Having one autoimmune disorder raises the chance of a second. The broader picture of causes and early warning signs is covered on our autoimmune disease page. This page focuses on the types and how they differ.

List of autoimmune disorders by body system

Organ-specific autoimmune disorders

Systemic autoimmune disorders

These affect many organs at once, mostly through connective tissue and blood vessels:

• Rheumatoid arthritis: symmetrical swelling of small joints of the hands and feet, with morning stiffness over an hour. Can also affect lungs and eyes.
• Lupus (SLE): joint pain, a facial rash, mouth ulcers, hair loss, and inflammation of the kidneys, heart lining or brain.
• Sjögren's syndrome: dry eyes and dry mouth from attack on tear and saliva glands, often with fatigue and joint pain.
• Scleroderma (systemic sclerosis): skin thickening, Raynaud's phenomenon, and scarring of lungs or gut.
• Vasculitis: inflamed blood vessels, which can damage kidneys, lungs, skin or nerves.
• Dermatomyositis and polymyositis: muscle weakness of the hips and shoulders, sometimes with a violet rash on the eyelids.

When features of two or more systemic disorders appear together, doctors call it an overlap syndrome.

Common symptoms across autoimmune disorders

Because the target varies, symptoms vary. Several features are shared by many types:

• Fatigue that rest does not fix
• Joint and muscle pain, with or without swelling
• Rashes, especially ones that worsen in sunlight
• Low-grade fever and a general feeling of being unwell
• Flares and remissions: symptoms come and go, often over months
• Swollen glands, hair loss, dry eyes or mouth, and numbness or tingling in the hands and feet

These signs are vague, so many people see several doctors before a diagnosis is made.

Why autoimmune disorders are more common in women

About 80% of people with autoimmune disease are women. Estrogen tends to strengthen immune responses, and some immune genes sit on the X chromosome, of which women have two. Lupus is about 9 times more common in women, and Sjögren's and Hashimoto's are similarly skewed. Symptoms often change around pregnancy, after childbirth and at menopause. Rheumatoid arthritis often eases in pregnancy and flares after delivery. Lupus needs planning before pregnancy because active disease raises the risk of complications.

How autoimmune disorders are diagnosed

There is no single test. A doctor combines your history, an examination and targeted tests:

1. Antinuclear antibody (ANA): a screening test for systemic disorders such as lupus. A positive result is common in healthy people too, so it means little without matching symptoms.
2. Specific antibodies: for example anti-dsDNA (lupus), rheumatoid factor and anti-CCP (rheumatoid arthritis), anti-TPO (Hashimoto's), tissue transglutaminase (celiac), and acetylcholine receptor antibodies (myasthenia).
3. Inflammation markers: ESR and CRP rise in active inflammation.
4. Organ tests: thyroid hormones, blood glucose, kidney function and urine protein, liver tests, blood counts.
5. Imaging and biopsy: MRI for multiple sclerosis, a small-bowel biopsy for celiac disease, a skin or kidney biopsy where needed.

Referral is usually to the specialist for the main organ involved: a rheumatologist, endocrinologist, neurologist, gastroenterologist or dermatologist.

Treatment

Treatment depends on whether the organ is destroyed or still being attacked.

• Replacement therapy: when an organ has stopped working, replacing its product is enough. Examples are thyroid hormone in Hashimoto's, insulin in type 1 diabetes, and steroid hormones in Addison's disease.
• Anti-inflammatory medicines: NSAIDs ease joint pain. Steroids such as prednisone calm flares fast but are kept short or low-dose because of side effects.
• Disease-modifying drugs: methotrexate, hydroxychloroquine, azathioprine and mycophenolate reduce immune activity over months and allow lower steroid doses.
• Biologics and targeted drugs: antibodies or pills that block a specific immune signal, such as TNF, IL-17, IL-23 or B cells. They have transformed treatment of rheumatoid arthritis, psoriasis, inflammatory bowel disease and multiple sclerosis.
• Avoiding triggers: a strict gluten-free diet is the whole treatment for celiac disease. Sun protection helps lupus. Stopping smoking improves rheumatoid arthritis and Graves' eye disease.

People on immune-suppressing treatment need regular blood tests, up-to-date vaccines (ask before any live vaccine), and prompt attention to fevers.

Outlook

Most autoimmune disorders are lifelong, but outcomes have improved sharply. Many people reach long periods of remission. Early treatment matters most for disorders that cause permanent damage, such as joint erosion in rheumatoid arthritis, kidney scarring in lupus and disability in multiple sclerosis.

Frequently asked questions

What are the most common autoimmune disorders?

In the US, the most common include Hashimoto's thyroiditis, Graves' disease, rheumatoid arthritis, psoriasis, type 1 diabetes, celiac disease, vitiligo, inflammatory bowel disease, multiple sclerosis and lupus. Thyroid autoimmunity is the most common of all, especially in women over 30.

What is the difference between organ-specific and systemic autoimmune disorders?

Organ-specific disorders attack one tissue, such as the thyroid in Hashimoto's or the pancreas in type 1 diabetes. Systemic disorders, such as lupus, rheumatoid arthritis and scleroderma, target proteins found throughout the body, so they can affect joints, skin, kidneys, lungs and blood vessels at the same time.

Can you have more than one autoimmune disorder?

Yes. About a quarter of people with one autoimmune disorder develop another. Common pairings are type 1 diabetes with celiac or thyroid disease, and rheumatoid arthritis with Sjögren's syndrome. Doctors often screen for these partners, for example checking thyroid function yearly in type 1 diabetes.

Are autoimmune disorders hereditary?

Partly. Genes raise the risk, so autoimmune disease often clusters in families, but usually as different disorders in different relatives. Most people with an affected parent never develop one. An environmental trigger, such as an infection or smoking, is usually needed as well.

Can autoimmune disorders be cured?

Most cannot be cured, but they can be controlled. Some, like celiac disease, go fully quiet when the trigger is removed. Others, like rheumatoid arthritis and multiple sclerosis, can be held in long remission with modern disease-modifying drugs and biologics.

Does a positive ANA test mean I have an autoimmune disorder?

No. Up to 1 in 5 healthy people, especially women and older adults, have a low positive ANA. It only points toward a disorder such as lupus when there are matching symptoms or other specific antibodies. A doctor interprets it together with your history and examination.