Dangal actor Suhani Bhatnagar’s demise spurs efforts to raise awareness about autoimmune diseases: Doctors

The news of Dangal's child actress Suhani Bhatnagar's demise at 19 left the world shocked and baffled. While we are yet to adjust to the news of young individuals succumbing to cardiac arrests, the unfortunate loss of this young actress has brought to light yet another health concern that requires our attention.

As per the details issued to the media, Suhani suffered from dermatomyositis, an autoimmune disease. When reading about the condition that led to this tragic incident, two terms were used quite often - autoimmune disease and inflammatory disease. We asked the concerned health experts what these terms mean, who all are at risk of such diseases, their health implications and the necessary treatments.

What are autoimmune diseases?
Dr Puneet Mashru, consultant-rheumatologist, Sir H N Reliance Foundation Hospital elucidates, "Your immune system typically protects you from diseases and infections by creating specific cells to target foreign pathogens (organism that causes disease) when it detects their presence. Normally, your immune system can distinguish between foreign cells and your body's cells. However, in the case of autoimmune diseases, this process goes awry. Your immune system mistakenly identifies parts of your body, such as your joints or skin, as foreign invaders. Consequently, it releases proteins called auto-antibodies, which attack and damage healthy cells instead of protecting them."

Expanding on the same, Dr Rohini Samant, consultant rheumatologist, P. D Hinduja Hospital and Medical Research Centre, Mahim states, "This means that the body's immune system which is meant to counter external elements like microorganisms /allergens has gone overboard and is attacking oneself. If untreated, this may lead to damage to vital organs like lungs, kidneys, heart or liver, eventually leading to death."

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What are inflammatory diseases?
Dr Preeti Nagnur, consultant rheumatologist, Wockhardt Hospitals Mira Road, comments, "Inflammatory diseases are a group of conditions characterised by the body's immune response causing inflammation in various parts of the body. In cases of chronic inflammatory diseases, this response becomes dysregulated and can cause damage to healthy tissues. One key feature of inflammatory diseases is the presence of certain proteins called cytokines that play a significant role in regulating inflammation. Imbalance in these cytokines can lead to chronic inflammation and contribute to the development of diseases like rheumatoid arthritis, inflammatory bowel disease, and asthma."

How are autoimmune diseases different from inflammatory diseases?
According to Nagnur autoimmune diseases and inflammatory diseases are often confused as they share common symptoms but differ from each other.

Autoimmune diseases occur when the body's immune system mistakenly attacks its tissues, leading to chronic inflammation and tissue damage.

Inflammatory diseases are caused by a response to an external threat like infection or injury, resulting in acute inflammation as a defence mechanism.

One way to differentiate between autoimmune and inflammatory diseases is through diagnostic tests that identify specific antibodies in autoimmune conditions. These tests are crucial in determining whether the immune system is attacking self-tissues or responding to an external threat.

Understanding the distinction between autoimmune and inflammatory diseases is vital for accurate diagnosis and appropriate treatment decisions.

Rheumatologists or immunologists are trained to treat such diseases.

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What are the common types of autoimmune diseases?
Autoimmune diseases can affect any part of the body, from the skin to the joints to internal organs.

Though almost any organ can be affected, Dr Pradeep Hasija, consultant, cardiology, Jaslok Hospital and Research Centre, Mumbai, spells out two major patterns of autoimmune diseases.

1. Organ-specific autoimmune disease - In this the expression of autoimmunity is restricted to specific organs of the body, such as the thyroid (graves' disease), pancreas (type 1 diabetes mellitus), intestine (coeliac disease), colon (crohn's disease and ulcerative colitis), nerve fibres (multiple sclerosis), lacrimal and salivary glands (sjogren syndrome),
joints (rheumatoid arthritis).

2. Systemic autoimmune diseases - Many body tissues are affected, such as systemic lupus erythematosus (SLE) affecting multiple organs involving joints, skin, kidneys, and nervous system. Likewise, dermatomyositis affects predominantly skin and muscles.

Hasija goes on to clarify, "The unfortunate demise of the ‘Dangal' actress at the young age of 19 has brought autoimmune diseases into focus in recent times. Though complete medical details have not been shared in the media, such rapid progression of disease requiring ventilatory support suggests severe affection of lungs or weakness of respiratory muscles and probably heart (myocarditis) in the inflammatory process."

Mashru adds, "Anyone can develop this condition, but it most commonly occurs in children aged five to 15 and adults aged 40 to 60. Dermatomyositis tends to affect women more often than men."

Key symptoms of dermatomyositis may include
1. Muscle weakness, stiffness, or soreness, leading to difficulty climbing stairs, sitting and getting up from chairs, and raising arms overhead. Over time, weakness can progress to involve the oesophagus, causing swallowing difficulties.
2. Rashes may occur on sun-exposed areas, upper eyelids, knuckles, and fingers. In some cases, the lungs may be affected, leading to lung fibrosis and shortness of breath.
3. Associated symptoms can include inflammation in the joints, fever, and unexplained weight loss.
If someone experiences persistent rashes accompanied by weakness, it is important to consult a doctor for evaluation of dermatomyositis.

Diagnosis of dermatomyositis typically involves blood tests such as CPK (creatine phosphokinase), SGOT and SGPT as well as imaging studies like MRI of muscles, electromyography (EMG), and sometimes muscle biopsy. Early diagnosis and treatment are essential for managing the symptoms and preventing complications associated with dermatomyositis

The most common type of autoimmune disease is rheumatoid arthritis. It occurs when the immune system mistakenly attacks the joints. This can lead to inflammation, pain, and stiffness in affected joints, causing significant discomfort and limiting mobility for individuals with this condition. Rheumatoid arthritis is commonly associated with older adults, but it can also affect individuals in younger age groups.

Another prevalent autoimmune disease is multiple sclerosis (MS), characterised by the immune system attacking the protective covering of nerve fibres in the brain and spinal cord. This causes symptoms such as fatigue, muscle weakness, and problems with coordination. Multiple sclerosis can affect individuals across a wide age range, but it most commonly manifests in young adults between the ages of 20 and 40.

Systemic lupus erythematosus (SLE) is an autoimmune condition where the immune system mistakenly targets and damages its own tissues, leading to inflammation and harm in various organs such as joints, skin, brain, lungs, kidneys, and blood vessels. Fatigue, skin rashes, fevers, and joint pain or swelling are common symptoms. SLE is seen in the age group of 15-45.

"The less common but more serious ones, often with multisystem involvement, are systemic lupus erythematosus, inflammatory myositis (like dermatomyositis), primary Sjogren's syndrome, vasculitis, and scleroderma," states Samant of P. D Hinduja Hospital.

Further, speaking about inflammatory diseases, Nagnur of Wockhardt Hospitals states, "Inflammatory diseases can manifest in various forms, with some of the most common types including inflammatory bowel disease (IBD), and asthma. IBD encompasses conditions like crohn's disease and ulcerative colitis, characterised by chronic inflammation in the digestive tract. Asthma involves inflammation of the airways, resulting in breathing difficulties and wheezing. The causes of inflammatory diseases involve a combination of genetic predisposition, environmental factors, and immune system dysfunction."

The terms autoimmune and inflammatory disease are often used interchangeably.

What are the common causes of autoimmune and inflammatory disease?
"It's unknown what specifically causes autoimmune disorders. People who have certain genes may be more likely to have autoimmune disorders. Although genes contribute, they alone are insufficient to trigger an autoimmune disease. Environmental triggers, including infections, certain medications, smoking, and UV light exposure, are also believed to contribute to the development of autoimmune diseases," says Mashru of Sir H N Reliance Foundation Hospital.

Why diagnosis of autoimmune and inflammatory diseases is difficult?
"Diagnosing autoimmune and inflammatory diseases can be a complex and challenging process due to the wide range of symptoms that can mimic other conditions," says Nagnur.

A persistent constellation of symptoms in different combinations should arouse suspicion of an autoimmune disease. Common medical conditions which can also cause these symptoms should be first excluded.

When in doubt, early referral to a rheumatologist by the treating physician will enable early diagnosis and treatment.

Expanding on the same, Samant opines, "Early diagnosis of these rare diseases is still a far cry. The reason for this is the general lack of awareness of these conditions in the community and also sometimes the nonspecific nature of the symptoms in the initial phase of the disease."

She goes on to state that many people are unaware of who a rheumatologist is and what they treat. "Even among general practitioners, there is only a superficial understanding of these diseases. This is due to a lack /deficiency of rheumatology training in the undergraduate and postgraduate medical curricula since rheumatology is still a relatively new branch. There is therefore a skewed ratio of trained rheumatologists to the general population. All this is changing slowly with many institutes now offering super speciality programmes in rheumatology/immunology in our country."

What are the common symptoms of autoimmune/inflammatory diseases?

Mashru lists down some common symptoms:

1. Joint pains accompanied by early morning stiffness and swelling.
2. Raynaud's phenomenon, is characterised by the fingertips turning blue or white upon exposure to cold temperatures or stress.
3. Muscle weakness, resulting in difficulty sitting, standing up, and raising arms overhead.
4. Unexplained fever and weight loss, which can be indicative of systemic inflammation.
5. Persistent rashes, often sensitive to sunlight (photosensitive), may present in various forms depending on the specific autoimmune disease.

These symptoms can vary in severity and may overlap among different autoimmune rheumatic diseases

Can such diseases be treated for a complete cure?
Nagnur says that while a complete cure may not yet be available for all autoimmune and inflammatory diseases, various treatments can help manage symptoms and improve quality of life. From medication therapies targeting specific immune responses to lifestyle modifications such as diet and exercise can help patients. Patients must work closely with the doctor to determine the most suitable treatment plan.

When struck with inflammatory and autoimmune conditions, patients often make the mistake of self-diagnosing or ignoring early symptoms. This lack of medical advice can lead to delayed treatment and worsen the condition. Another common mistake patients make is non-compliance with prescribed medications or treatment regimens. Inflammatory and autoimmune conditions require consistent management to control symptoms and prevent flare-ups. Patients must actively engage in their treatment plan, communicate any concerns with their doctors, and adhere to recommended lifestyle changes.

Can these diseases be prevented?
According to Samant, there is no medicine at present to prevent these diseases. A well-balanced diet including fresh green leafy vegetables, fruits, proteins (pulses, lentils and meat), nuts and fish for omega 3 fatty acids, adequate rest, physical exercise, quitting smoking/tobacco, better-coping strategies for stress, avoidance of UV radiation by use of sunscreen (for systemic lupus erythematosus) are measures that will help prevent flares of autoimmune disease.

Since these diseases need long-term care, continuation of medicines, and watching out for red flags (as discussed by doctors), periodic checkups will go a long way in ensuring disease control.

Reaching the rheumatologist early rather than late is key to effective treatment and damage prevention.

Disclaimer: This information does not replace professional medical advice. Consult a qualified specialist or your physician for personalised guidance.