Handbook of Disabilities Autoimmune Disorders

Copyright 2001, Curators of the University of Missouri & RCEP7 1

Autoimmune Disorders

Description of the Disability
Autoimmune disorder is an umbrella term for a variety of painful conditions involving a
malfunction in the bodys complex immune system. Normally the immune system protects the
body from invading microorganisms such as viruses or bacteria. As part of this system, the
immune cells have to be able to distinguish the cells of the invading organisms from the cells of
the body itself. Scientists call this distinguishing Self from Other. Sometimes the ability to
distinguish Self goes awry for a variety of reasons and the immune system begins to attack an
organ of the body as if the cells of that organ were invaders.

In a normal immune response to an infection or invasion, the immune system causes a temporary
inflammation while it kills off the invader cells. In autoimmune disorders, this inflammation
become chronic, causing pain and permanent changes in or damage to the tissues involved. For
example, in rheumatoid arthritis, chronic inflammation damages the joints cartilage.

There is no specific cause for autoimmune disorders. In general, they are not infectious. Some of
the autoimmune disorders may be inherited, although it is probably a susceptibility that is
inherited rather than the disease itself. In some cases, a cluster of family members seem to have
inherited a susceptibility to autoimmune disorders, but different family members have different
specific disorders. Some disorders appear to be triggered by viral infections, among other things,
but this does not mean the virus causes the disorder, only that it acts as the final factor leading to
noticeable symptoms. There are other possible triggers, including aging, chronic stress, and
hormones. Hormones are of special significance, since many women only develop an
autoimmune disorder after menopause, during pregnancy, or after pregnancy. In Lupus (see
below) sunlight can act as a trigger. There may also be other environmental factors contributing
to susceptibility.

Most autoimmune disorders show patterns of remission and recurrence. Most are chronic, and
some are progressive. Functional issues can vary tremendously between disorders, depending on
the organs involved, and may even vary from individual to individual. The course of any of the
disorders is unpredictable and the persons doctor will need to monitor each person with an
autoimmune disorder.

Autoimmune disorders can be very difficult to diagnose because the specific disorders have
different possible symptoms, many of the symptoms are initially subtle, and individual
symptoms can vary. In some cases, individuals may have a diagnosis of Autoimmune Disorder
NOS (Not Otherwise Specified). Sometimes a doctor has to monitor a persons symptoms for
several months or years before refining the diagnosis to a specific disorder.

Types of Autoimmune Disorders include:
Rheumatoid Arthritis - a disease in which the immune system attacks the lining of the
joints. Seen entry on Arthritis.
Handbook of Disabilities Autoimmune Disorders
Copyright 2001, Curators of the University of Missouri & RCEP7 2
Systemic Lupes Erythematosus (SLE or Lupus) In Lupus, the immune system
attacks various parts of the body, but the most common symptoms are fever, weight loss,
hair loss, profound fatigue, joint pain, skin sores, and rashes (the word Eythema means
skin rash). There can also be damage to any of several organs, including the brain,
kidney, heart, blood (leading to clots and stroke) and lungs. Typically the disease starts
with damage to one organ and later involves other organs.
Multiple Sclerosis In MS, the immune system attacks the Central Nervous System,
leading to mobility issues and, in serious cases, to blindness, paralysis, and death. See
entry on MS.
Myasthenia Gravis This disorder is caused by an attack on the muscles of the body,
starting with the face. Symptoms include drooping eyelids, double vision, difficulty
swallowing, difficulty breathing, difficulty talking, and progressive weakening of the
body.
Type I Diabetes (Immune Mediated Diabetes) The immune system can attack the
insulin-producing cells of the pancreas, causing diabetes. See entry on Diabetes Millitus.
Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis) In these
diseases, the immune system attacks the intestine, causing nausea, cramping, diarrhea,
fatigue, and general pain.
Psoriasis In psoriasis, the immune system attacks the skin, and sometimes the eyes,
nails, and joints. It causes a build-up of scales (called plaques) on the skin (the result of
accelerated skin cell growth), which look similar to calluses. These plaques may affect
small portions of the skin or cover most of the body, and are accompanied by itching and
inflammation.
Graves Disease Graves Disease involves over-activity of the thyroid, which can be
caused by an autoimmune condition, among other possible causes. The over-activity of
the thyroid damages the gland and disrupts the endocrine system. It can also result in
protruding eyes, restlessness, fatigue, heat intolerance, and other symptoms.
Scleroderma In Scleroderma, the immune system attacks the skin and blood vessels,
causing them to thicken. The most common consequence is Reynauds Syndrome a
sensitivity of the hands and feet to cold. Sclorderma can also cause reduced movement
and shortness of breath. In severe cases there may be damage to kidneys, heart, or lungs.
Reiters Syndrome - Reiters causes inflammation and pain in the joints and tendons
usually in the lower extremities. It can also cause inflammation of the eyes conjunctiva
and the mucous membranes such as in the mouth.
Addisons Disease - Addisons is a disease resulting from damage to the adrenal glands,
causing a deficiency in the secretion of adrenocortical hormones. Symptoms can include
weakness, fatigue, nausea, and skin rashes or lesions.

Incidence Statistics
Most autoimmune diseases are more common in women in men. In particular, they are
more common in women of working age and during their childbearing years.
Handbook of Disabilities Autoimmune Disorders
Copyright 2001, Curators of the University of Missouri & RCEP7 3
Approximately 50 million Americans have autoimmune disorders. 75% are women.
Lupus is more common in African-American and Hispanic women than in Caucasian
women .
1 in 700 people experience multiple sclerosis .
Type 1 diabetes is usually diagnosed before the age of 30, often in the first months of life.
1 in 500 Americans has an inflammatory bowel disease.
Psoriasis occurs in 2% (2 in 100) of Americans and often runs in families.

Common Treatments, Medications, and Side Effects
In general, treatment for chronic autoimmune disorders involves control of the symptoms, which
can vary depending on the specific disorder involved. Because pain and inflammation are
common symptoms for almost all of these disorders, the most commonly used drugs are the
Nonsteroidal Anti-inflammatory Drugs (NSAIDs), such as aspirin of ibuprofen, to control the
inflammation and pain (see Drug entry on NSAIDs for side effects). More advanced conditions
may be treated with Corticosteroids such as prednisone (see Drug entry on Corticosteroids).

Some autoimmune disorders can be sent into remission, or at least slowed down, with
immunosuppressant drugs, which are used (in moderation) to bring the immune system back
under control. The consequence of this, however, is that the person may be more vulnerable to
colds, other infectious diseases, and infected cuts. A few specialized immunosupprressant drugs
are targeted to specific parts of the immune system. As researchers develop more of these
targeted drugs, doctors will be able to address only those parts of the immune system involved in
specific disorders. See Drug entry on Immunosuppressants for side effects.

If hormone or enzyme secreting organs are involved with the disorder, such as the pancrease in
Type I Diabetes or the adrenal gland in Addisons Disease, drugs may be needed to supplement
the reduced function of the organ. In serious cases, surgery may be required to deal with the
consequences of the tissue damage to, for example, the joints in Rheumatoid Arthritis.

Possible Functional Issues
Reduced stamina.
Reduced strength
Reduced range of motion
Reduced mobility
Reduced eye-hand coordination
Reduced dexterity
Difficulty concentrating (if pain is not controlled)
Difficulty with cognition (if brain is involved)
Handbook of Disabilities Autoimmune Disorders
Copyright 2001, Curators of the University of Missouri & RCEP7 4
Sensitivity to sunlight (especially with Lupus)

Initial Interview Considerations
Initial Questions
How has the disorder affected their ability to work?
How often do they have to take breaks when they are doing something?
How has it affected their activities of daily life?
Is there a pattern to their symptoms? Are the symptoms worse at particular times of day
or during particular activities?
Have they noticed any triggers for their symptoms?
If the disorder involves the GI Tract (Inflammatory Bowel Disease, for example), how
often do they have to use the restroom? How would they deal with it in a work situation?
How often, if ever, do they have trouble concentrating because of pain? How do they deal
with that?
What side effects do they have from medications?
What changes have they made in their eating schedule, if any, because of medication?
What problems do they have with mobility or coordination?
What problems do they have, if any, with sleeping? Are they often tired during the day?
Are there any activities they have to avoid?
How is their endurance? How often do they have to take breaks when doing something
active?
What hobbies do they have? (Gets at types of activities in which they can participate)
How long can they drive? Can they drive long distances, or do they have to limit
themselves to short trips?
How well can they type or use a computer?
How would they feel about a job interacting with the public?
Initial Observations
Do they appear to have any trouble with manual dexterity?
Ask them to write or copy a paragraph so you can check their writing ability.
How is their mobility?
How is their endurance? Do you see any signs of fatigue?
Handbook of Disabilities Autoimmune Disorders
Copyright 2001, Curators of the University of Missouri & RCEP7 5
Interview Accommodations (if any)
If you come down with a cold just before the interview, call the person and offer to
reschedule. (The persons immune system may be reduced if they are taking immune
suppressant drugs.)

Possible Accommodations and Assistive Technology
Flexible schedule.
Frequent breaks for rest, or even naps, if fatigue is a problem.
Breaks to allow specialized eating times, if necessary because of medication.
Accommodation devices for gripping handles, if gripping strength is a problem.
Speech recognition software, if typing is a problem.
Wheelchair or mobility cart if mobility is an issue.
Job sharing.

Career Planning Issues
Stamina and fatigue may be a significant issue.
Consider the pattern of symptoms if the symptoms are relatively constant or if they
come and go periodically. The accommodation needs may be very different.
Consider steps to be taken if the disorder progresses in the future. Discuss what
accommodations may be useful in that situation. Make sure the person is aware they can
return to VR when they need further help.
Work history is likely to be good.
Social skills are usually not affected.
Learning skills and problem solving skills are usually not affected.
For most disorders, cognitive skills are usually not affected.

Emerging Issues
Treatment
Awareness
Research on causes

Additional Information Resources

American Autoimmune Related Diseases Association: www.aarda.org/
Handbook of Disabilities Autoimmune Disorders
Copyright 2001, Curators of the University of Missouri & RCEP7 6
National Institute of Allergy and Infectious Diseases (part of the US Dept. of Health):
www.niaid.nih.gov