Courtesy of THIS Quarterly magazine
 
 
Autoimmune Diseases of the Elderly
   
     
 
The body’s immune system is usually a very efficient system that keeps the body healthy and free of infections. However, like every biological system, it is imperfect, and certain stimulus may cause it to start turning on the body itself. This is what is known as an autoimmune disease.

Autoimmune diseases are usually treated through immunosuppression, i.e. the use of certain drugs that weaken the body’s own immune system, in the process minimising the symptoms and effects of the disease. However, as one may expect, immunosuppression brings with itself certain problems and disadvantages: a person on immunosuppressive drugs will usually have a greater susceptibility to infections and even cancer. However, this can usually be minimised through the use of drugs that only target the part of the immune system that has become diseased.

An example of an autoimmune disease that tends to affect the elderly is polymyalgia rheumatica (PMR). Typically presenting as pain or stiffness in the neck, shoulders and hips, the pain from PMR can be either very sudden or occur gradually over a period. Most PMR sufferers experience pain in the morning when they first wake up, though this is not necessarily true for all patients.

While the causes of PMR are not yet fully understood, we can identify the source of the symptoms as being the result of white blood cells in the body attacking the muscles, causing inflammation, pain and stiffness. If left untreated, PMR may sometimes cause temporal arteritis, an inflammation of blood vessels in the temples that may cause blindness if not quickly brought under control. For this reason it is extremely important that patients with PMR correctly manage their condition, typically through the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) and prednisolone, an immunosuppressive corticosteroid. Some patients need other medicines to help control the immune system so that they do not need to rely on too much prednisolone.
  Another common autoimmune disease that affects the elderly in particular is dermatomyositis, a connective-tissue disease that affects the muscles and skin. While it may manifest as a result of the patient having an underlying cancer, dermatomyositis may also be the result of an autoimmune disorder. Patients often experience significant weakness in their arms and legs, so much so that it can be difficult for them to even raise their arms above their heads or climb up the stairs without support. The development of lesions, scaly eruptions and red patches over the joints is another characteristic of dermatomyositis, as is the appearance of periodic rashes and calcium deposits under the skin.

Thankfully, like PMR, dermatomyositis can be kept under control relatively well through the use of immunosuppressive drugs. However, treatment should begin as soon as possible, so as to minimise the amount of damage that the disease causes.
 
 
 
A/PROF LEONG KENG HONG

MBBS (Singapore) 1983
Master of Medicine (Singapore) 1989
Doctor of Medicine 2005
Member of the Royal College of Physicians (UK) 1989
Fellow of the Academy of Medicine, (Singapore) 1992
Fellow of the Royal College of Physicians (Edinburgh) 1997

Leong Keng Hong Arthritis and Medical Clinic
6 Napier Road #04-18
Gleneagles Medical Centre

Singapore 258499
Tel : (65) 6472 4337
Fax : (65) 6472 0691
Email : info@leongkenghong.com
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