Our immune system does a remarkable job of keeping most of us mostly healthy for most of the time. After all, we live surrounded by parasites: bacteria, viruses, fungi, pathogens and archaea. Usually, the immune system mounts devastating attacks on pathogens and malignancies, while limiting collateral damage to healthy tissues (self-tolerance). Sometimes, however, the immune system provokes an damaging reaction against triggers (antigens) expressed by healthy, normal tissue, such as the skin, pancreas or joints.1
This immunological civil war underlies about 80-100 autoimmune diseases.2, 3 Some are part of nurses’ everyday caseload, including psoriasis; multiple sclerosis (MS); inflammatory bowel disease (IBD); rheumatoid arthritis (RA); and type 1 diabetes. You may only occasionally, if ever, encounter others, such as epidermolysis bullosa acquisita,4 Vogt-Koyanagi-Harada disease5 and Parry Romberg syndrome.3 Autoimmune mechanisms also contribute other conditions, such as chronic obstructive pulmonary disease (COPD),6 Cardiovascular disease7 and certain cancers.8,9 This feature outlines the processes that underlie autoimmune diseases to help nurses appreciate the importance of rapid diagnosis, referral and treatment.