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Why Do Autoimmune Conditions “Collect”? – Part 1

Why Do Autoimmune Conditions “Collect”? – Part 1

If you’re reading this article, it might be because you saw the title and thought “yes, this is me!” If so, you are not alone. Outside of our chronic autoimmune community, the idea of “collecting” conditions may seem bizarre, but within our community, it’s a topic that comes up frequently. Here’s an example of what I hear on a daily basis from members:

“Why is your first autoimmune disease like a magnet for others?”

“Does anyone else here also suffer from Crohn’s Disease and Sjogren’s?”

“I must have hit the jackpot, I have rheumatoid arthritis AND psoriatic arthritis!”

The research surrounding this phenomenon is fragmented and still in its infancy, but my purpose for writing this article is to try and summarize a bit of it for you. In Part 1, most importantly, I want to share some relevant medical terms that you can use to start your own digging. Here are three I think you’ll find interesting.

Polyautoimmunity

“What!” you say? “There’s an actual term for this?” Yes! Polyautoimmunity describes the presence of more than one autoimmune disease in an individual. It’s perhaps been most closely studied in relation to autoimmune thyroid diseases, but the scope spreads beyond that. It’s estimated that up to 20% of the population may suffer from at least one autoimmune condition, and within that population there may be up to a 35% incidence of polyautoimmunity.1 The mechanisms beyond polyautoimmunity are not well understood, but may include scientific mouthfuls like “molecular mimcry” and “epitope spreading”; we’ll explore these and other theories in Part 2.

Multiple Autoimmune Syndrome (MAS)

The term “Multiple Autoimmune Syndrome” was first fully described in 1988 by Humbert and Dupond and is a more specialized description of polyautoimmunity.2 Even though it was first proposed more than three decades ago, MAS is a term just now catching on, and describes those of us with at least three autoimmune conditions. Here’s another interesting fact: of those people with three autoimmune conditions, one of the conditions is usually dermatological.3

There are currently three “types” of MAS, and these serve to group together autoimmune conditions that tend to be concurrent.3 For example, Type II includes rheumatoid arthritis, Sjogren’s, scleroderma, cirrhosis, and autoimmune thyroid disease. How many of you could add a Type IV that includes psoriatic arthritis, Sjogren’s, psoriasis, non-alcoholic fatty liver disease (NAFLD)*, fibromyalgia, and Hashimotos? The study of MAS is, by extension, the study of what autoimmune conditions are most likely to “group” together.

Familial autoimmunity/aggregation

If MAS and polyautoimmunity are where various autoimmune diseases are present in the same individual, familial autoimmunity is where many different autoimmune diseases (or the same autoimmune disease) are present within the same family. Familial autoimmunity suggests a genetic susceptibility that may underlie autoimmunity. The most common autoimmune disease in familial autoimmunity is autoimmune thyroid disease (Graves Disease, Hashimotos, etc.), followed by Systemic Lupus Erythematosus and rheumatoid arthritis.4

What makes it so hard to tease out the underlying genetic factors is that the responsible genes are not what scientists call “high penetrance,” and therefore do not exhibit classic inheritance characteristics that would make them easy to pin down. In addition, family members from the same household are likely to have a number of overlapping environmental factors as well, which further complicates the issue. Identical twin studies are one of the best tools for separating genetic from environmental factors, but the only PsA twin study to date found no difference in PsA rates among identical and non-identical twins, so the search for non-genetic causes continues!5

Final thoughts

My hope is that Part 1 of this article has demonstrated that epidemiology agrees with us: once you have one autoimmune condition, you’re more likely to develop another one. In addition, there are clusters of autoimmune diseases that are more likely to group together. Your suspicions are not just in your head, there are established terms to describe this phenomenon and there is more and more research being done every day.

In Part 2, I explore some of the theories behind the “why.” What can the current research tell us about why autoimmune diseases collect? Read Part 2.

*Editor’s Note: NAFLD is typically categorized as a metabolic syndrome and not an autoimmune disorder. An example of an autoimmune disorder specifically impacting the liver is autoimmune hepatitis.6

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Psoriatic-Arthritis.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Rojas-Villarraga A, Amaya-Amaya J, Rodriguez-Rodriguez A, Mantilla RD, Anaya J-M. Introducing Polyautoimmunity: Secondary Autoimmune Diseases No Longer Exist. Autoimmune Diseases. 2012;2012:1-9. doi:10.1155/2012/254319.
  2. Humbert P, Dupond JL. [Multiple autoimmune syndromes]. Ann Med Interne (Paris). 1988;139(3):159-168. PMID: 3059902.
  3. Cojocaru, M, Cojocaru, IM, Silosi, I. Multiple autoimmune syndrome. Maedica (Buchar). 2010 Apr; 5(2): 132–134.
  4. Cárdenas-Roldán J, Rojas-Villarraga A, Anaya J-M. How do autoimmune diseases cluster in families? A systematic review and meta-analysis. BMC Medicine. 2013;11(1). doi:10.1186/1741-7015-11-73.
  5. Pedersen OB, Svendsen AJ, Ejstrup L, Skytthe A, Junker P. On the heritability of psoriatic arthritis. Disease concordance among monozygotic and dizygotic twins. Annals of the Rheumatic Diseases. 2008;67(10):1417-1421. doi:10.1136/ard.2007.078428.
  6. National Organization for Rare Disorders. Autoimmune Hepatitis (2016). https://rarediseases.org/rare-diseases/autoimmune-hepatitis/

Comments

  • Dorcas
    9 months ago

    I completely understand where you are coming from. I hesitate to tell people in my new (4 years town) because the list is long. At my favorite hospital I get embarrassed when they read out the list for verification. Lol
    First let me say I can trace my mother and fathers family trees easily because until me they pretty much stayed in the same area since the 1830’s. Both got their water from artisan wells, possibly from the same deep earth water. They grew their own foods and my father couldn’t stand spraying our veggies and we grew outlet own beef. No autoimmune diseases until around 1982 and my mother got Lupus. It wasn’t easy to get layman info back then. Many years later I learned my psoriasis I’d gotten at age 6 (1970) was an autoimmune disease. Mom died in “84. In 2001 I was diagnosed with PsA then Fibromyalgia (had Endometriosis in 90’s and many get FMA later). Then Antiphospholipid Antibody Syndrome and two genetic mutations that also cause ‘sticky blood’ (clots too easily.). My family did have lots of heart attacks and strokes. My daughters are 23 and 29 and they’ve got genetic blood mutations too because my hubbys family (from many states away and they never have heart attack’s etc, had the same two mutated genes) so my girls have two copies each. I could scream. Btw my Antiphospholipid…. is also known as the Lupus Clotting disease and I have been checked for 20 years or more. Never have lupus. I’ve a host of other health issues like GERD, IBS, High blood pressure…. but my mother seems to have gotten hers out of thin air. Many of my cousins lived within shouting distance and none of them have these. Same water on my mothers side and soil.
    Loved your story and look forward to part II

  • VickiN moderator author
    8 months ago

    @dorcas, thank you SO MUCH for reading! I’m very happy that you enjoyed the content. If you’d like, Part 2 is published here:
    https://psoriatic-arthritis.com/answers/autoimmune-conditions-collect-part-2/
    How are you managing now with everything? Do you feel like you have a good healthcare team in your new town? Rest assured that if you ever need a safe space to share, you can come here 🙂
    Happy to have you,
    -Victoria, Community Moderator/Author

  • jennyb
    9 months ago

    Oh I forgot the iritis, and the blood clots! I take Warfarin every day and test my own blood at home.

  • jennyb
    9 months ago

    I have psoriasis (not active), psoriatic arthritis, MS, rosacea, Menier’s disease, Reynauds, and a history of Hodgkins Disease two times, which is a cancer of the lymph system, known now is lymphoma. I call whatever it might be as the “diease de jour “ I also have symptoms of Sjogren’s but I didn’t test positive for it. I also have broken my foot and my arm, and have tachycardia. I can’t wait for the other shoe to drop. My dad had psoriatic arthritis and I am 63 years old.

  • Eurotrekker
    1 year ago

    This is so me! I have ankylosing spondylitis, erythema nodosum, psoriasis, psoriatic arthritis, restless leg syndrome, rheumatoid arthritis, and Sjögrens syndrome, which are all autoimmune diseases. I also have lymphedema, GERD, asthma, have had part of my right lung removed because it died. They assumed it was a clot that lodged for long time and it cut off the blood flow, but dissipated before found. (I kept telling them that something was wrong, but was actually told that it was anxiety and that I know how women are.. they’re emotional! This ticked me off. I was a professional woman who had lived and worked in foreign countries as a missionary/teacher and at that time was recruiter for an airline and the team captain for an emergency response team, in case there was ever a crash. Believe me, you have to have nerves of steel to see the aftermath of a plane crash and still function.) However, they have never found blood clots in my system, so it really is a mystery. I was diagnosed with an autoimmune disease after the lobectomy. I’m very prone to staph infections, have been hospitalized with carbon dioxide build up in my blood stream, had diabetes and hypertension, but now have those to under control. Whew! I hate going to doctors, because it seems I’m always diagnosed with a new illness. In fact, I just got a call from my immunologist and he said I was ‘significantly’ anemic. I’m undergoing tests to see what is causing that now. Last week I had to have surgery, because of non-stop eye watering. It seems like it never ends. I almost feel like I’ve been to medical school from all of my various diagnoses.
    Thank you for your article.

  • VickiN moderator author
    1 year ago

    @eurotrekker, I would have been so mad to have my symptoms passed off as feminine hysteria (just boils my blood to think you went through that!). I’m sorry you’re struggling with so many conditions, I hope there’s a small comfort in knowing this is very common and you’re not alone.
    Let us know how your anemia tests turn out, this can be a problem for those with any inflammatory arthritis as I understand it. In one of our community recommendation articles we reviewed the Lucky Iron Fish, which can help if the underlying cause is lack of iron.
    https://psoriatic-arthritis.com/living/favourite-things-products-compression-wear/

    Thanks for taking the time to comment. I’m glad you enjoyed this article! I’m busy writing the second part 🙂
    -Victoria, Community Moderator

  • lydiamene
    1 year ago

    I found this extremely interesting I have systematic Lupus, PsA, Hypothyroidism,and Fibromyalgia. With zero familial connection. the thyroid issues are connected to almost every family member.

  • VickiN moderator author
    1 year ago

    @lydiamene, thanks for reaching out, I’m so glad that you found it interesting. Have you ever had skin issues like psoriasis too? Before writing this I didn’t realize that thyroid autoimmune disease “collections” were the most studied. It’s a big field! Sometimes I think that the research happening in hospitals and research centers doesn’t always do a great job of trickling down to us. I hope that you are coping with everything okay. Know that we’re always here and that you’re not alone in this community.
    -Victoria, Community Moderator

  • lydiamene
    1 year ago

    Yes I have the psoriasis elwith the PsA. I read all of these comments and articles as I have learned so much. When I was first diagnosed years ago there wasn’t the information that is available now.

  • imschmarte
    1 year ago

    I found this fascinating! Not only do I have 6 autoimmune conditions, but so do my brother and sister, and my sisters daughter. My sister has a couple more than us, but basically we all have the same. Very interesting reading, can’t wait for part 2 VickiN!! And to Jax53, I also have the pustular psoriasis on my hands and feet, and it is miserable when it is active. I have been in many research studies for different drugs, and most of them work on the arthritis, but very few work on the psoriasis. I found remicaide after many years of trial and error, get a rheumatologist, and check it out! Good luck!

  • VickiN moderator author
    1 year ago

    Hi @imschmarte! So glad you’re looking forward to Part 2! It’s tricky because there’s so much scientific jargon to wade through, but it was too interesting a subject not to tackle. I’m learning a ton doing research for the second part, I think it’s going to be pretty interesting 🙂 Always happy to see you on here!
    -Victoria, Community Moderator

  • imschmarte
    1 year ago

    Sounds interesting! Can’t wait!! Thanks Victoria for taking the time and effort to do it!! Am looking forward to part 2!!

  • Angiebabe55
    1 year ago

    Hi, happy to read your article. I thought I was the only one with several autoimmune problems. I have had IBS since I was 19, now 62. Recently been diagnosed with osteo and Psoriatic arthritis. Although I had wear and tear problems on my lower lumbar when I was 17. Psoriasis has been on and off since my teens. I always say to people who ask why I dont work now, that I am totally unreliable in my timekeeping. Mostly due to IBS but also with the pains.I think I am fine and set off for a walk them BAM the hip locks up. Sick of being sick now.

  • VickiN moderator author
    1 year ago

    @angiebabe55, “I’m sick and tired of being sick and tired” is sort of like our motto around here! We all very much relate. Those of us with psoriasis and psoriatic arthritis are also more prone to developing IBS (I have it too, goodness gracious is it ever a pain). We have sister communities if you want to reach out to them too: PlaquePsoriasis.com and IrritableBowelSyndrome.net
    I hope that you find some comfort in knowing that you’re not alone in this struggle, and that it’s definitely not in your head. Warm wishes to you, we’re here whenever you need a sympathetic ear!
    -Victoria, Community Moderator

  • Angiebabe55
    1 year ago

    Thank you so much Victoria x

  • Jax53
    1 year ago

    Hi, Vicki, I have Psoriasis called Pustular Psoriasis on my hands and feet, I have 2 types of Arthritis, Which are Osteoarthritis, and Psoriatic Arthritis, I am in despair, I had to have hand surgery when I had that I went into a huge Flare-up, which has not settled down at all, I believe that Autoimmune Diseases can collect, I am living proof, I had a Tumour, I have Diabetes, I have had Heart Failure, and my heart is not beating as strong as it was, I have been told my heart is tired.I have always felt that there is more to come, But here in Bristol my disease is not thought of as a threat, more a comedy of Errors, I am stuck in no man’s land, little drug therapy, not anywhere near what America has to offer, I want to put myself forward as a guinea pig, and get some positive actions in my life.

  • VickiN moderator author
    1 year ago

    @jax53, doing the research for this article was a real eye-opener for me. I knew that this phenomenon was real, but I was shocked at how well described it was in the literature. I’m so sorry to hear that you fall into the percentage of people who have more than one. You are not alone in this boat, and we’ll be here to support you. I live in Canada but I’ve actually been to Bristol before. What treatments are you currently trying?
    Hugs to you today,
    -Victoria, Community Moderator

  • Jax53
    1 year ago

    It has been for me too, I am going to see my Dermatologist next month, and I am going to ask for new medication, such as Enbrel, I heard about this today, have downloaded the paperwork, and want to try it, I wonder are there any drug trials for this medication, I don’t feel I am being taken seriously, I was told it was in my head, I was also told there was nothing wrong with my knee, and it was only when I demanded a second opinion they did an MRI and found my knee was being eaten away, and due to the severity of the Arthritis, was told my body is trying to lay down extra bone to accomodate it, I was left for 6 years because they told me nothing was wrong.

  • VickiN moderator author
    1 year ago

    @jax53, if you want a brief summary of some biologics (including Enbrel) this may be useful for you:
    https://psoriatic-arthritis.com/medications/biologics/
    Our editorial team has also put together some questions before starting a clinical trial:
    https://psoriatic-arthritis.com/clinical/is-a-clinical-trial-right-for-me/
    Have you looked up any in your area? Usually your Doctors will cycle you through biologics and other systemics before recommending clinical trials, but it’s totally individual. I would also recommend you get a referral to a Rheumatologist if you can to address the psoriatic arthritis if you haven’t already (it’s so frustrating to need so many specialists!).
    Very glad that you found this community,
    -Victoria, Community Moderator

  • mich54
    1 year ago

    I can beat that. I have been trying for 30 years to get someone to believe that I have joint problems. What it finally took was for me to get psoriasis on my scalp and then look it up on the internet and found PsA. It was like a light bulb! Soon after that, my ankle swelled up. And years ago I had my finger swell up and my wrist. When I finally brought all this to my doctor’s attention…he started to Believe something was wrong! But I had to be the one to come up with the details (and the pictures of the swelling of my ankle and wrist…. and the psoriasis)…. it’s like NO one believes you until they see some form of physical proof!! And now, my stiffness is so bad…and I had a heart blockage 10 years ago (which I believe is due to having this undiagnosed for so long.) I had psoriasis on my scalp when I was little, but never mentioned that to doctors because I didn’t think it was of any significance to all my joint stiffness.

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