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BioStock’s article series on autoimmune disease: The Patients

BioStock’s article series on autoimmune disease: The Patients

27 juni, 2019

Autoimmune diseases are on the rise, and no one has a clear answer as to why. More than 100 autoimmune disorders have been documented, and most burden patients with chronic pain and other debilitating symptoms and often strike at an early age. BioStock has compiled a four-part article series to dig deeper into the challenges for patients suffering from autoimmune diseases, the progress being made by the research community, and the struggles for biotech companies to develop drugs targeting such disorders. In this first segment, we talk with Li Alemo Munters, who represents Reumatikerförbundet, an organisation focused on helping patients suffering from rheumatoid arthritis, one of the most common autoimmune disorders.
We think of our immune system as a strong army of cells that defends us from anything that the body perceives as toxic or foreign. Microorganisms such as bacteria and viruses are the most common examples of foreign invaders targeted by our immune cells to rid us of infections like the flu, but those are only the tip of the iceberg.
There are situations, however, when some immune soldiers go rogue and decide to attack cells within the body that are meant to be there and that have done nothing wrong. This glitch in the system is characteristic of autoimmune diseases: disorders of the immune system where the body’s defences mistakenly identify innate cells as foreign invaders, thus creating a chronic and unstoppable immune response that leads to a wide range of debilitating symptoms, including excruciating pain.

Autoimmune disorders are still a mystery

Up to 100 disorders are listed as autoimmune, depending on the type of cells and the organs that are affected, as well as the symptoms that arise. The vast range of disorders makes them a challenge to understand and develop treatments for. While many studies point to a strong genetic component leading to autoimmune disease, direct causes are still unknown.
Speculation about probable causes mainly revolve around the fact that we live in much cleaner environments these days, so clean that our immune systems have too little to fight against, thus causing them to revolt against healthy cells.

»A pharmaceutical treatment early in the disease phase has shown to improve prognosis including work ability. But, for almost 40 per cent of RA patients in Sweden, existing pharmaceutical treatments are not effective« — Li Alemo Munters, Head of Research at the Swedish Rheumatism Association, Reumatikerförbundet

Evidence also points to the increase of processed foods and added sugars in our daily diets as a possible cause for the higher incidence rates. It seems that the excess of “junk” food can create an imbalance in our immune systems that could potentially lead to autoimmunity.

The X chromosome could spell trouble for women in particular

What’s also clear is that women are disproportionately affected, representing ¾ of patients being affected by such disorders. Many experts make the case that sex hormones must be involved somehow, and that the answers lie on the X chromosome. Yet, still little progress has been made in terms of identifying directed causes for these diseases.

New treatments are necessary

A cure for autoimmune disorders doesn’t exist, and the incidence continues to rise dramatically. For now, patients mainly rely on immunosuppressant drugs such as corticosteroids or anti-inflammatory compounds like ibuprofen to manage the symptoms, but long-term use leads to life-threatening side effects. So, the demand for new treatments is high.

Funding is lacking

Unfortunately, while health care costs related to autoimmune disorders are larger than those of cancer, funding toward autoimmune disease research does not even come close to that of cancer research. According to the American Autoimmune Related Disease Association (AARDA), the NIH has spent approximately 591 MUSD on autoimmune disease research, or approximately 1/12 of the amount spent on cancer research (6.1 BUSD).
The situation is not any better in Europe. A European Parliament report on autoimmune diseases explains why funding is limited, siting the unknown causes, challenges diagnosing such diseases, and the heavy economic burden on society; “so long as autoimmune diseases are not studied as a group, and are considered instead under a common umbrella category, funding will primarily be channelled to specific autoimmune diseases, while all-encompassing research efforts will be more limited.”

RA and MS patients in the spotlight

Two of the most common autoimmune diseases are rheumatoid arthritis (RA) and multiple sclerosis (MS). Both are chronic disorders that lead to crippling health consequences, with some symptoms overlapping one another. RA is an inflammatory disease of the joints causing pain and swelling in the small joints at first, then spreading to larger joints and other organs potentially. Besides pain, RA also causes fatigue, loss of function, and disability. MS originates from the central nervous system (CNS) where nerve fibres degenerate causing blurred vision, tingling of the limbs, and loss of balance among other symptoms.
The median debut age for RA is 55-60 years of age, whilst MS typically debuts before the age of 50 and is quite common among young adults. Furthermore, while neither disease is considered fatal, both can lead to life-threatening complications. In both cases, women are at least twice as likely to develop symptoms compared to men, and genetics play a major role since family history is considered a considerable risk factor.
In Scandinavia, both diseases have high prevalence compared to other nations world-wide. This is especially true for MS, which has been shown to have a prevalence of 189/100,000 in Sweden; of the highest rates in the world, according to one study. That same study sites a higher risk of MS with increasing north latitude, leading experts to speculate an association between low levels of vitamin-D and MS risk.

In conversation with Reumatikerförbundet

Due to the vast array of autoimmune diseases, BioStock has decided to focus on RA and MS for this four-part article series, since they are among the most common. For part I, we caught up with Li Alemo Munters, PhD and Head of Research at the Swedish Rheumatism Association, Reumatikerförbundet. She discusses some of the most pressing challenges for rheumatoid arthritis patients and for the respective research and medical communities.
*We should note that we reached out to Neuro, a Swedish patient organisation focused on helping patients suffering from neurological disease, including MS. However, they declined to participate in this article series.
Li Alemo Munters, could you tell us about the main goal of the foundation?
– The Swedish Rheumatism Association, SRA, is Sweden’s largest patient organisation. The SRA is a non-profit organisation that, since 1945, has been working for people with rheumatic and musculoskeletal diseases (RMD). We support our 46,000 members in their everyday effort to cope with their diseases. We also strive to persuade decision-makers on all levels of society to embrace our goal – that all people with an RMD can enjoy life fully and completely. Our vision is to find the cure for rheumatism.
–  In terms of research, the SRA is the largest individual donor to Swedish rheumatology research. We support research that is relevant and important to persons with rheumatisms. Furthermore, we try to persuade decision makers and other research funding institutions to include patient involvement in the research they fund.
What are the main challenges for patients in terms of healthcare?
– The main issue is accessibility to rheumatic healthcare for an early diagnosis, which is important for the disease severity, prognosis, and to prevent disease damage. A prerequisite for an early and effective treatment is a diagnosis. A pharmaceutical treatment early in the disease phase has shown to improve prognosis including work ability. But, for almost 40 per cent of RA patients in Sweden, existing pharmaceutical treatments are not effective. These patients need to be offered other treatments such as rehabilitation (physical exercise and patient education). There is a lack of rehabilitation within rheumatic care in Sweden, and the needs of patients with insufficient pharmacological treatment effects are usually not met.
Is the Swedish healthcare system adequately equipped to properly diagnose and treat autoimmune disease?
– For the most part rheumatic care in Sweden is of high quality, however, accessible rheumatic care is not equal in the different regions of Sweden.
Why, in your opinion, has it been so difficult to pinpoint the cause of autoimmune disease?

Li Alemo Munters, Head of Research at Reumatikerförbundet

– The cause is thought to be multi-factorial; both genetic and environmental risk factors contribute. Moreover, to further complicate the understanding of the disease mechanisms, RA has different subgroups in which different factors contribute to the disease development. For example, an individual at genetic risk of developing RA could limit the risk of developing the disease by not smoking and by engaging in a physically active lifestyle.
BioStock would like to thank Li Alemo Munters for her contribution to this article series. Stay tuned for part two of the series on Tuesday, July 2, where Li Alemo Munters will represent Reumatikerförbundet once again in discussing the challenges within RA research. 
The content of BioStock’s news and analyses is independent but the work of BioStock is to a certain degree financed by life science companies. The above article concerns a company from which BioStock has received financing.

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