NMAC Systemic Autoimmune diseases

Systemic Autoimmune diseases are group of diseases which have something common. The immune system is hyper-reactive to the own organs and produces inflammation which attacks the patient's organ like kidney, lungs , brain , joints , gut, blood , liver, nerves, heart , skin, etc.

These diseases are lifetime diseases and if they are not diagnosed and treated they can have very disabling outcomes in patient's health therefore they should be diagnosed and treated early. The earliest we treat the patient we can have the best outcomes. Due to the chronicity, the disease should be monitored and managed periodically in order to avoid progression of the disease or any organ damage. Allow me to detect any changes in the behavior of the disease as your doctor so we can act timely in front of any relapse.

Last but not the least, another reason to have a close medical consultation is that these diseases have demonstrated increment in the cardiovascular risk, even more than a patient with conventional CV risks like Diabetes, hypertension , thyroid disorders , etc.

The most common rheumatic and autoimmune disease I have seen here in Bermuda so far are Rheumatoid Arthritis and Systemic lupus erythematous which are the most frequent diseases. One particular patient is an elderly man, in his 70's ; which in fact my first rheumatic patient in Bermuda , who has been without proper treatment since several years ago, patient has already structural damage in some of the joints with deformities and loss of function due to uncontrolled longstanding disease; i have started treatment with the first line of therapy Methotrexate and hydroxychloroquine and he has kept a close follow up with me and after 3 months the patient got remission which means free of symptoms and has returned to his normal life and came back to exercise and incorporated to social life.

The other interesting case is a female patient in her 30's with diagnosis of systemic lupus which has been treated for long period unsuccessfully , prior my assessment she has had multiple admissions at the KEMH with recurrent flares given by pleural effusion with multiple evacuation of the fluids in the lungs. I have seen her and started to treat with immunosuppressant therapy and now she is on IV treatment with cyclophosphamide feeling better with prednisone tapering and without relapses since more than 3 months ago , she has followed a strict monitoring of her disease , has been adhered to her treatment.

The third case is another female in her 70's with Systemic sclerosis with interstitial lung disease, treated with immunosuppressant several years ago with progression in her lung disease despite the treatment. This patient was referred to me and I have started new medication with a biological treatment. The patient has improved her parameters of lung inflammation, feeling better from clinical standpoint and I am waiting for her lung function and CT chest control for further confirmation of stable disease. She has kept a strict control as well demonstrating that close follow up , adherence to the treatment is the key of success in the management.

This is the importance of the strict follow up by the Rheumatologist. In my consultation I take my time to explain the disease with details , the patient's education regarding the disease is a cornerstone in the treatment so that the patient can understand what's happening with him/her, to know how the treatment is acting in the body and what are the goals of the treatment and benefits.

Thus far, there is no cure for autoimmune diseases but with strict control and treatment it is possible to ease the disease to an extent to have no symptoms at all, these days there is much progression in the treatment and new alternatives in the field to offer the patient as well as many others in development in order to get the target which is remission.

In conclusion, the best care of an autoimmune disease is early diagnosis and close consultation with the appropriate doctor in order to get remission which means free of symptoms and avoid all the consequences secondary to the active disease.

Follow us this month as we discuss more about how these diseases affect the Bermuda population, the symptoms, treatments and how I work on a holistic team at NorthShore Medical to treat you.

Fermin Gonzalez, MD.
Internal Medicine & Rheumatology
EULAR board certified in Rheumatology

Northshore Medical & Aesthetics Center