Friendly fire: When the body attacks itself Bushes' diseases call attention to autoimmune failings

THE BALTIMORE SUN

When Camille Marx was diagnosed with lupus four years ago, she had never heard of it. And she didn't have the faintest idea what an autoimmune disorder was.

Now that autoimmune disorders have hit the White House, though, the condition is being discussed everywhere from scientific laboratories to radio talk shows.

Lupus -- which First Dog Millie suffers from -- is an autoimmune disorder, as is Grave's disease, which has been diagnosed in both President and Barbara Bush. Both conditions are the result of the body's immune system mistaking a part of the body for a foreign invader and attacking it.

For Ms. Marx, the current public interest is one more step in helping her deal with lupus, a disease that affects 1 of every 2,000 Americans, causing such symptoms as skin rashes, joint pain and swelling, sensitivity to sunlight and anemia.

"I'm thrilled to have it in the public eye," said Ms. Marx, 47. "I found it very depressing to know that I was sort of destroying myself but I couldn't do anything about it. But the more I learned about the disease, the more control I felt I had."

Dr. Noel Rose also appreciates the newfound interest. Until a month ago, when he told people what his specialty was, they often responded with confusion or a yawn.

"I've worked all my life on autoimmune disease," said the chairman of the Department of Immunology and Infectious Diseases at Johns Hopkins School of Hygiene and Public Health, "and no one cared about it. When I told them what I did, they thought I was talking about cars.

L "Now," Dr. Rose has found, "it's all people can talk about."

The current attention is welcomed by the medical community in general, who hope it will translate into additional funding for research, as well as helping doctors diagnose autoimmune diseases.

"The hardest part of diagnosing a thyroid disease [such as Grave's disease] is considering the possibility" of the immune system as the culprit, explained Dr. Paul Ladenson, director of endocrinology and metabolism at Johns Hopkins Hospital.

In Grave's disease, which affects 0.4 percent of the U.S. population, the thyroid gland becomes overactive, producing too much of the hormones that regulate body metabolism.

Autoimmune diseases occur when the immune system responds its own cells as if they were foreign cells, producing antibodies to attack them. Normally, the immune system recognizes its own cells; an autoimmune disorder results when the system's recognition function fails.

There are two types of autoimmune disorders. Grave's disease is an example of those that attack a specific organ. Lupus is the type in which autoimmune activity is spread throughout the body.

Other autoimmune diseases include pernicious anemia, Addison's disease (which involves the adrenal glands), insulin-dependent diabetes mellitus, rheumatoid arthritis and multiple sclerosis.

Although statistics are not available on how much of all disease is autoimmune, it represents a significant part of the illnesses that attract medical attention.

In fact, autoimmune diseases are no stranger to the White House. President Kennedy was a victim of Addison's disease, while President Eisenhower suffered from Crohn's disease, an intestinal disorder that is thought to be autoimmune in origin.

The big mystery surrounding autoimmune diseases is why they occur. Physicians have noted a genetic predisposition to autoimmune diseases (something they say the Bush children should be aware of). Many also believe there may be some kind of infectious agent or environmental trigger that activates the immune system to begin attacking itself.

Despite suspicions about a trigger, however, a number of scientists said they were dubious about recent efforts to find something in the water of the White House or the vice president's residence to explain the Bushes' medical problems.

Dr. Ladenson added that while it is unusual for a husband and wife to both suffer from Grave's disease, it is not unprecedented. "I have one such couple in my own practice," he said. "When you've got a big country with a lot of people, it's bound to happen."

Another suspected mechanism for setting off autoimmune disease is immunologic over-reaction. For example, in rheumatic fever, a streptococcus infection is attacked so vigorously by antibodies that the heart valves become damaged.

That autoimmune diseases are prevalent is no surprise if you understand the human immune system, said Dr. Douglas Fearon, a Hopkins rheumatologist and immunologist. "Sometimes the individual is sacrificed so that the herd survives," is the way he described some of the basic principles at work."

A person's "immune system has to be effective enough to attack bacteria, viruses, fungi, parasites, anything that can colonize living tissue," he explained. "The immune system has to figure out a way to recognize all that [as distinct from] itself. The problem is incredibly difficult, especially when you consider that bacteria and other organisms mutate rapidly in an attempt to fool the immune system."

The good news, Dr. Fearon added, is that with current scientific research, "everyone has a sense that we're on the threshold of beginning to home in on understanding this."

Millie's illness

Until recently, First Dog Millie's fame has come from her unique role in writing a book. (Actually, her owner, Barbara Bush, is said to have helped with the wording.)

But these days, Millie's name is being mentioned in a more mundane context: the dog suffers from lupus, an autoimmune disease in which the body's immune system attacks its own cells. According to veterinarians, it is no more unusual for animals to have autoimmune diseases than it is for people.

"Any animal has the potential for an autoimmune disease," said Dr. Bill Benson, a Reisterstown veterinarian. "We probably see them more in dogs than any other companion animal, but that may be just because people are more willing to spend money on diagnosing their dogs."

Interestingly, hyperthyroidism -- which is comparable to Grave's disease, the autoimmune disorder that afflicts both President and Mrs. Bush -- has been diagnosed in cats more and more frequently in the past decade. The increase, Dr. Benson said, is probably because "we see a lot more elderly cats than we used to."

The cluster of autoimmune diseases in the White House has prompted speculation about transmission of such conditions between pets and their owners. This possibility has been the subject of at least three studies since 1977, when two families were observed in which both dogs and family members had lupus or other autoimmune diseases.

The studies have shown no evidence of animal-human transmission, said Dr. Marc Hochberg, a Johns Hopkins Hospital rheumatologist and epidemiologist, involved in some of the research.

Nevertheless, there is still the possibility that the same outside agent may be triggering autoimmune diseases in human and their pets, Dr. Hochberg added.

By Randi Henderson

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