Siloed Specialties & Treatments for Autoimmune Diseases

Autoimmune Diseases are Siloed by Specialty

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Looks a mess, doesn’t it? It is! Autoimmune diseases are scattered across many different medical specialties, creating a siloed landscape in which patients must coordinate and navigate for themselves.

This illustration maps high-prevalence autoimmune diseases (white bubbles) onto the different medical specialties that treat them. Adding up only the 14 marquee diseases on the chart produces an autoimmune patient population of at least 62-75M people, much larger than the top-down estimates for all 100+ AIIDS of 24-50M. Why is this not on more VC’s radar?

Rheumatology (green) is the specialty that for historical reasons, treats the most autoimmune conditions. These include SLE/lupus, Sjogren’s plus all the inflammatory arthritides: spondyloarthritis (SpA), rheumatoid arthritis (RA), psoriatic arthritis (PsA), etc. The latter overlaps with dermatology; most PsA patients are referred to rheumatologists by dermatologists treating their earlier psoriasis Dx. Likewise, many lupus patients have kidney damage, treated by nephrologists, and many cases of RA have heart involvement, treated by cardiologists.

It’s obvious how difficult it is for autoimmune patients to manage their diseases across siloed specialties, especially since patients are primarily responsible for their own care coordination. In most cases, their specialists don’t even communicate with each other!

What Are Autoimmune & Autoinflammatory Diseases (AIIDs)?

Autoimmune & inflammatory diseases are caused by the immune system damaging the cells and tissues of the host organism. Both the innate and adaptive immune systems play a role in this dysfunction. The innate immune system causes immunoinflammatory conditions, that is, chronic inflammation due to increased activity from macrophages and cytokines. In classic autoimmune diseases, T and B cells of the adaptive immune system incorrectly identify normal self-cells & tissues as pathogens or damaged, attacking cells from their own host. This destruction increases inflammation in the area of the attack, thus attracting more immune cells and continuing chronic progressive tissue damage. 

The Spectrum of Autoimmunity

Given that the science of immunology is less than 200 years old and still playing catch-up to oncology (which is also far from crystal clear!) our medical-scientific understanding is still very incomplete. This is evident in the still-fluctuating terminology: autoimmune, autoinflammatory, immune-mediated, etc. 

Given the complexity of our dual immune systems, it’s not surprising that AIIDs fall on a spectrum from autoinflammatory (innate immune system over-activation) to autoimmunity (adaptive immune system cells attack normal tissues) with mixed factors in between. Most named diseases fall in the middle, which explains the varied symptom clusters, unclear diagnoses, flares, and trigger reactions, all reflecting the unique nature of people’s immune systems. The siloed specialties approach has made research, development, diagnosis, and treatment more difficult.

Comorbidities

Comorbidities also cross medical specialties, making it even more difficult for patients to manage their care. Some of these conditions include mood disorders (anxiety, depression), organ dysfunction (heart, kidney), obesity, and multiple autoimmune diagnoses, among others.

• 50% of RA patients have cardiovascular comorbidities, including atherosclerosis, coronary heart disease, stroke, thromboembolic events, and heart failure. Some are caused by the RA itself.
• 50% of adults with lupus also have kidney disease, often caused by the autoimmune attack.
• 80% of children with lupus have kidney disease, usually caused by the lupus

There is a significant overlap between obesity and type 2 diabetes, and these often also exacerbate OA/RA. Obesity contributes to increased joint stress, which worsens all arthritic conditions.

Mood disorders, especially anxiety & depression, affect ~50% of autoimmune patients. Perhaps autoimmune processes themselves trigger anxiety & depression, or maybe it is the stress of dealing with chronic diseases (often with suboptimal help from the healthcare system), especially ones that involve chronic pain, fatigue & sleep disorders.

Polyautoimmunity

• 25% of autoimmune patients have polyautoimmunity, meaning more than one concurrent autoimmune diagnosis.
• Multiple auto-immune syndrome (MAS) = 3 or more diagnoses.
• A reminder that diagnosis ≠ disease! These patients likely have an underlying systemic immune dysfunction that manifests in different body systems.
• This shows three autoimmune diagnoses that overlap in many patients.
• Psoriasis is generally treated by dermatologists, who are often the first clinicians to note joint pain/stiffness and refer PsA patients to rheumatologists, who treat RA & Sjogren’s.

Medical Philosophies

Due to the siloed nature of conventional specialties treating autoimmunity, and their limited perspectives, many patients are attracted to the more holistic approach of alternative practices, like integrative, functional, or lifestyle.

Conventional Western Scientific Medicine, aka Allopathic: Relies on blood & imaging diagnostics, pharmaceuticals & procedures (surgery). Reaching diminishing returns in treating chronic conditions (obesity, cardiac, diabetes, kidney, lung, AIIDs). Also becoming increasingly expensive because of misaligned incentives (3PP, FFS) that encourage over-testing, polypharmacy & unnecessary surgery.

Lifestyle Medicine is now making inroads into conventional care, in part to address chronic diseases not responsive to the conventional paradigm. The Pillars of Lifestyle Medicine are diet, exercise, mental health, restorative sleep, relationships, and avoiding risky substances. So far, diabetes, obesity, cardiac, and musculoskeletal (MSK) patients are increasingly likely to be offered lifestyle interventions as adjuncts and to reduce the use of pharmaceuticals.

Alternative medicine is a catch-all term for a variety of techniques, including heterodox relics of the pre-antibiotic age (naturopathy & osteopathy), borrowings from non-western & indigenous medicine (Traditional Chinese Medicine, Ayurvedic Medicine, yogas, shamanism) and more recent experiments in ethnobotany & psychedelics, as well as a variety of movement therapies (Feldenkrais, Pilates, Gyrotonic).

Functional Medicine seeks to use blood tests (often unorthodoxly interpreted) to identify the “root cause” of the patient’s symptoms and applies diet & supplements to address them. Integrative Medicine stirs practices from other philosophies into unique approaches, depending on the practice.

Read our other 2023 State of Autoimmunity posts below!

• The Chronic Disease Epidemic: Visible & Invisible
• Autoimmune Incidence & Prevalence
• The NIH Report: “Enhancing NIH Research on Autoimmune Disease”

Authors: DrBonnie360, Ellen M Martin, & Ellie Duvall

We approach these thought leadership posts from our multi-lens perspectives. 

• DrBonnie360: Digital health consultant, clinical dentist, Wall Street analyst, patient & advocate.  
• Ellen M Martin: Consultant, editor, life science finance/IR/marcomm, autoimmune caretaker.
• Ellie Duvall: Digital health equity research intern, recent B.S. in Physiological Sciences from UCLA.

Strategic Consulting & Professional Services

We provide professional consulting services to investment, emerging, and established companies. Our work bridges silos and fills gaps to help our clients improve care for AIID patients while reining in costs. Informed by patient and caretaker perspectives, we guide investors & clients to integrate the best of digital, conventional, and lifestyle medicine into AIID care delivery.

• We help our clients leverage digital innovations into V1C for AIID patients. 
• Our subject matter expertise includes: Oral health, microbiome, patient engagement, competitive analysis, strategic positioning & messaging, digital health, and self-hacking.
• We have decades of experience in finance, marketing, and communications for healthcare and life sciences organizations, emerging and established.
• Our backgrounds include clinical dentistry, osteology, biotech. IR/PR, marcomm, content creation, strategic consulting, and autoimmune advocacy.

Contact us to help you map your market landscape and understand patients’ unmet needs. We can help you clarify and articulate your company’s market position and differentiators. Long before COVID-19, we were facilitating virtual sessions. We create compelling content: articles, blog posts, collateral, e-books, web copy, and white papers. See our Autoimmune Connect website showcasing our own content.