Nutrition and Oral Medicine (Nutrition and Health)

242 Part IV / Select Diseases and ConditionsTable 1Target Antigens of Selected Autoimmune DisordersPresence in autoimmune disease (% of cases)Non-organ-specific autoimmune disordersOrgan-specific disordersAuto-antibody type SLE RA SS PA PV BMMPAntinuclear 96–100 30–60 95Anti-native DNA 60 0–5 0Anti-rheumatoid factor 20 72–85 75Anti-Sm 10–30 0 0Anti-Ro 15–25 0–5 60–70Anti-La 5–20 0–2 60–70Anti-intrinsic factor 60Anti-gastric parietal cell 90Desmoglein 3 100Desmoglein 1 50Bullous pemphoid antigen 2 100these disorders generally occur more frequently in women than in men and usually inindividuals over age 40. Autoimmune diseases may be organ specific (pemphigus vulgaris,mucous membrane pemphigoid) or non-organ specific (i.e., multiple organ systemsaffected) (SLE, SS, RA). Individuals with one autoimmune disease are more likelyto develop another; thus, it is not uncommon to find that patients have overlappingsymptoms and multiple diagnoses (i.e., SLE and SS). Table 1 summarizes the targetantigens of the autoimmune disorders discussed in this chapter, and each disorder isexplored in greater detail in subsequent sections.In general, autoimmune disorders are incurable and require continuous or periodictreatment to minimize disease-related sequelae. Treatment may be directed primarily atthe immune system with the objective of reducing autoantibody production or immuneactivation, at protection or replacement of the affected target tissue or cell, at relievingsymptoms, or a combination of the above. The common long-term use of immunosuppressantand immunomodulating medications presents significant risk for complicationssuch as opportunistic infection, increased risk for cancer, and a myriad of potentiallyserious metabolic and biochemical problems. Progress in the development of genetherapy, tissue transplantation, and monoclonal antibody therapy provides the promisein the near future of more specific treatments with fewer side effects. Table 2 summarizesthe spectrum of therapies for treating the autoimmune disorders discussed in this chapter,and Table 3 shows the related systemic, oral, and nutritional complications of thesemedications; details are discussed in subsequent sections.3. ORGAN-SPECIFIC AUTOIMMUNE DISORDERSPA, pemphigus vulgaris (PV) and benign mucous membrane pemphigoid (BMMP)represent autoimmune diseases with organ-specific antigen targets (see Table 1). Eachhas unique oral, systemic, and nutritional implications for the disease itself as well as forits therapy.