Systemic lupus erythematosus (SLE) is known as the “great imitator” because it has so many potential symptoms that it can mimic many other diseases. However, sometimes it is more like ‘a great masker,’ covering up the presence of other diseases. 

Other autoimmune diseases can be present alongside lupus. In fact, nearly 25% of people with autoimmune diseases have more than one present, a condition called polyautoimmunity or “multiple autoimmune syndrome.” While debilitating and difficult to navigate, managing all multiple autoimmune diseases is possible. It is even possible to bring them to remission, where the symptoms are dormant.

Polyautoimmunity and Lupus

Polyautoimmunity, also known as Multiple Autoimmune Syndrome is how medical professionals describe a combination of three or more autoimmune diseases that are present in the same person. For people with SLE, common co-existing autoimmune diseases include autoimmune hypophysis, hidradenitis suppurativa, fibromyalgia, Sjogren’s syndrome and rheumatoid arthritis. However, many other autoimmune conditions can co-occur with lupus, including scleroderma, myasthenia gravis, thyroid disease, dermatitis herpetiformitis, and diabetes. 

Symptoms of Polyautoimmunity and Lupus

Autoimmune diseases share a cause and so may have overlapping symptoms, and some might even be treated with the same methods. However, it should be clarified that are separate and interlocking diseases that can have different root causes. Sometimes treatments don’t overlap, and the treatment for one autoimmune disease could make the symptoms of the other diseases worse. Medical treatment teams for lupus should – and often do – screen for other autoimmune diseases once SLE is diagnosed. 

Many autoimmune diseases have symptoms in common, which can make this complicated, including:

• Rashes and other skin lesions
• Fatigue
• Brain Fog
• Pain
• Kidney Damage
• Anemia 
• Mouth ulcers and tooth issues
• Weakened immune system

Multiple autoimmune diseases can contribute to each of these symptoms, making treatment of all of the disorders necessary.

What Causes Lupus and Autoimmune Disease?

Autoimmune disease is caused by a combination of genetics and environmental stress. The genes involved tend to be differences in immune system activation, cell-to-cell signaling, and how cells proliferate. Whether these changes are overall good or bad is not clear, but they do appear to make certain groups of people more vulnerable to the ‘glitches’ in the immune system that cause autoimmune diseases.

Some people with autoimmune diseases find that a trigger incident like a major illness, injury, or traumatic life event seemed to tip things over the edge for their body and set off the noticeable symptoms of their disease. For others, it’s an accumulation of many events like job stress or exposure to pollutants. Sometimes, however, there is no clear ‘trigger’ or ’cause’ for the autoimmune disease. In either case, stress from mental and physical sources exacerbate the symptoms of autoimmune disease through inflammation.

Inflammation, stress, and autoimmune disease

Autoimmune diseases share a cause – the immune system is constantly set to high alert, a state called inflammation, and mistakenly attacks the body’s own cells.  Stress causes inflammation to increase, and inflammation itself stresses the body, creating a cycle of rising inflammation and autoimmune symptoms.

In addition to all autoimmune diseases being influenced by physical and mental stress levels, they can also share triggers. The stress from the different autoimmune diseases can affect each other, and different autoimmune conditions can go into remission at different times. It can be very complicated to navigate and manage several different conditions at once, with lupus having the added frustration of having such a wide range of symptoms. However, many autoimmune conditions use the same medications and lifestyle changes (including diet) to reduce inflammation, which does simplify treatment somewhat.

Treating Multiple Autoimmune Diseases and Lupus

While most autoimmune diseases are treated with immunomodulatory drugs such as steroids and immunosuppressants, they are different from each other and can respond differently to treatments. One of the reasons that it is important to know what autoimmune conditions a person has is that some therapies used to treat autoimmune conditions, particularly medications, can cause other conditions to become worse or trigger the symptoms. 

Glucorticoids, including prednisone, are used to treat the symptoms of lupus and other autoimmune diseases. They are very powerful medications but come with some severe side effects.

Aside from medications, people with lupus and other autoimmune diseases have several lifestyle changes that will benefit them. Eating a balanced, anti-inflammatory diet, getting regular exercise, regularly cleaning and sanitizing their environment, and reducing stress will reduce their symptoms and improve their health overall. Some people also react poorly to extremes in temperature and the stress of travel, which they are also advised to avoid. 

These lifestyle changes can be difficult but are possible for many people.

What is Renal Replacement Therapy?

Kidneys are vital organs, and damage done to them affects the entire body. Lupus Nephritis (LN) is the term for when inflammation caused by lupus severely damages structures in the kidneys known as nephrons. This kidney damage, which occurs in about 40-60% people with lupus, can lead to a loss of kidney function. Lupus causes other damage to the kidneys as well, including urinary tract infections, but in all cases, kidney damage and potential kidney failure is the source of the most serious symptoms of lupus.

The symptoms of lupus nephritis include fluid retention and swelling, joint pain, muscle pain, fever, high blood pressure, abnormal urine, and even the well-known malar rash of lupus. You can read more about kidney disease and lupus here. 

Lupus nephritis is very serious, but the treatments for it are very effective. 10-30% of people with LN develop end-stage renal disease and kidney failure, which increases their risk of death. As long as they do not enter renal failure, however, people with lupus can live normal, relatively healthy lives.

Renal replacement therapies are used to maintain their health and offset the damage to the body caused by nonfunctional kidneys. Dialysis is a form of renal replacement therapy that helps the body remove waste, salt, and extra water in the bloodstream. It also helps balance potassium and sodium, important chemicals for the body, and helps maintain blood pressure.  You can read more about it here.

Do Flares Happen While on Dialysis?

Yes. Disease flares can occur even while on dialysis, a renal replacement therapy where treatments (including machines) stand in for failing kidneys and filter the blood. It does not appear to reduce flares, though. People who experienced flares were also likely to experience flares under renal replacement therapy. 

In a study on 121 patients with SLE on dialysis (both hemodialysis and peritoneal dialysis) 26.4% of them experienced an SLE flare. Most of these people were treated with cortiosteroids, and 34.3% of people took additional immunosuppressants to combat disease symptoms and flares. Flares included fevers, thrombocytopenia (low platelet count,) and leukopenia (abnormal levels of white blood cells in the bloodstream.) Both of these are clear markers of increased inflammation and are expected in cases of flares.

Flares can occur right after dialysis, possibly caused by the dialysis itself, which does stress the body. Fatigue is a known side effect of hemodialysis though researchers are not entirely sure why.

Reducing Flares on Dialysis

Renal replacement therapies take on the function of the kidneys, removing waste products and maintaining a balance of dissolved materials and fluid in the  bloodstream. Doctors try to minimize reactions to dialysis by having it done in several short, intermittent sessions. This reduces the stress on the body and potential for flare triggering events.  For more severe acute renal failure, continuous dialysis has to be used, which can be harder on the body, but is necessary.

Most people with lupus are not using dialysis to control flares, but to avoid the symptoms of renal failure. Instead, they use immunosuppressive therapy, a key treatment for lupus nephritis, to reduce inflammation and avoid symptom flares.

People with lupus are also advised to drink plenty of water and stay hydrated. This helps to maintain good kidney health and takes some of the pressure off of the kidneys. It also has many other health benefits.

Dialysis is not necessarily forever! 28% of people with lupus nephritis restore enough kidney function to come off of dialysis. Keeping up the treatment is key and will reduce flares. 

Lupus treatments have come to a point where long-term survival and even remission is possible. However, many people don’t respond or find their symptoms reduced by the “gold standard” of lupus treatments for lupus. You can read more about lupus medications here. This includes glucocorticoids  such as prednisone, hydroxychloroquine, immunosuppressives, antimalarials, and certain anticancer drugs. This condition is known as Refractory Lupus. 

While uncommon, there are still many people who struggle with refractory and resistant lupus. In a study looking at 257 patients with systemic lupus erythematosis, about 6.2% of people being treated for lupus had refractory lupus, defined as not having improvement of symptoms even after intensive treatment. 

Lupus nephritis and systemic lupus, and neuromyelitis optica can all develop into refractory lupus. A good diet, good exercise, and a healthy lifestyle that avoids tobacco and alcohol can help, but researchers are developing alternatives to the gold standard medical treatment to relieve the symptoms further. 

Currently, researchers are looking at biologics and other therapies, such as mesencymal stromal cell or hematopoietic therapy, as potential treatments for refractory lupus.

Biologics for Refractory Lupus

Biologics are relatively new therapies that target the specific parts of the immune system that go haywire in lupus. They are produced by laboratory-modified cells to help people take control of their immune system. They are made from modified forms of immune system particles, such as antibodies, that are found naturally in the body. Some biologics mark autoimmune cells for destruction, others block cytokines, the signals that set off the overactive immune system. B cell-targeted therapies in particular have a lot of potential for people with refractory lupus.

Biologics are very precise and effective but also require people to go to the hospital and get an infusion or find a trained medical caretaker to help them with the injections. That makes them something of a burden for the patient.

Rituximab for Refractory Lupus?

Rituximab is one such a promising therapy for reducing symptoms in refractory lupus. Rituximab is a biologic drug that is often perscribed as a chemotherapy to combat non-Hodgkin’s lymphoma (which is a cancer that affects the white blood cells,) and rheumatoid arthritis. 

Researchers looked at 26 papers and compared the results of a total of 300 patients with an average follow up time of 60 weeks. Those who took B-cell ablation with the chimeric anti-CD20 antibody rituximab (RTX) had reduced symptoms of refractory lupus nephritis, and a few even entered remission. 

The side effects are fairly mild and are mostly because the medication is delivered via infusion, which can be stressful for the body. However, these symptoms can include fever, shaking, chills, tiredness, headache, or nausea

A Lupus Warrior’s Takeaway

Most biologics are currently not commonly available, unfortunately: Rituximab, calcineurin inhibitors, and other biologics (such as belimumab) are presently in the midst of some very promising clinical trials. It will take a few years for these trials to conclude and the researchers to have enough data to ensure that the side effects are acceptable.

The pancreas is very important, since it produces the enzymes that the body uses to breakdown proteins, sugars, fats, and starches into a form that the body’s cells can use for energy. It also produces hormones that regulate digestion, blood sugar levels, and whether we feel hungry or full. This makes it vital to maintaining a healthy weight and to a functional metabolism in general. The pancreas also holds channels that connect the liver to the rest of the digestive system. Bile from the liver drains through the pancreas into the first part of the small intestine, called the duodenum, where it begins to digest the broken-down food. 

The hormones that the pancreas produces include:

• Insulin – Insulin signals the body to store sugar in the cells instead of letting it freely flow in the bloodstream. 
• Glucagon – Glucagon signals the body to release stored sugars into the bloodstream to supply energy to the cells.
• Gastrin and Amylin – Gastrin and Amylin signals the stomach to produce gastric acid or continue digestion.

When lupus causes inflammation to the pancreas, these hormones might not be produced in adequate amounts.

What is the Digestive System?

Systemic lupus erythematosus (SLE) can have an effect on most organs in the body, including the organs of the digestive system. You can read more about the effects of lupus on the microbes that live in the digestive system here. This also includes the pancreas.

The digestive system is a series of organs that are responsible for taking in and processing food, extracting nutrients, absorbing water, and breaking down complicated molecules, including toxins. The digestive system also regulates the flow of nutrients, vitamins, minerals, and sugars in the bloodstream, keeping the levels balanced and the cells of the body healthy. The dietary intake of each individual person has a large effect on the digestive system. You can read more about important nutrients like Omega-3 fatty acids and lupus here. 

The digestive system works like a disassembly line, breaking down food into molecules that the body can use. 

First, food and water is taken in through the mouth, crushed into smaller pieces by teeth, moved around by the tongue, partially digested by saliva, before being swallowed to the esophagus. 

From there, it is broken down in the stomach by gastric acid and enzymes, before entering the small intestine where it is digested and nutrients are absorbed into the body through the membrane. 

In the large intestine, whatever material remains is collected, drained of any residual water, and finally excreted from the body as feces. 

The liver, pancreas, gallbladder, and other organs support this system with regulatory hormones, additional enzymes, and areas that process certain molecules. The kidneys are not considered part of the digestive system, but they do support it by filtering out waste products from the bloodstream.

Pancreatitis and Lupus

Pancreas-related problems are a rare symptom of autoimmune diseases such as lupus. Specifically, Lupus causes inflammation and swelling as it attacks the cells of the pancreas, a condition known as pancreatitis. Pancreatitis interferes with how the organ produces enzymes and hormones, and blocking the ducts that carry bile from the liver to the intestines. 

The symptoms of pancreatitis includes abdominal pain (including pain that feels like it’s at your back,) nausea, vomiting, and fever. 

Other causes of pancreatitis, including gallstones, alcohol use, genetic disorders, infections, or injuries to the abdomen, are much more common. It is estimated that only about 2-4% of cases of pancreatitis are caused by autoimmune disease, according to the National Library of Medicine. However, lupus medications such as immunosuppressants and the stress on the body from lupus can make the pancreas more vulnerable to infection and damage. You can read more about lupus medications here. 

Diabetes and Lupus

Diabetes is one of the major issues that can come about when the pancreas is damaged. Diabetes is a condition where the body doesn’t receive enough of a signal from the hormone insulin to properly modulate blood sugar levels in the body. When a carbohydrate or sugar-rich meal is digested, this lack of insulin causes a surge of sugar in the blood that can lead to problems in the kidney, heart, brain, and other organs. Diabetes can occur when the body stops reacting to insulin, but also if the pancreas is damaged and doesn’t produce enough insulin. 

For many reasons, including damage to the pancreas, people with SLE have a very high risk of developing diabetes. You can read more about diabetes and lupus here. Having both diabetes and SLE causes them to ‘feed into’ each other, one condition making the other worse and so on. It is important to treat both diabetes and SLE individually to get both under control.

Treating Pancreatic Issues and Lupus

People with lupus who have diabetes have to take regular insulin injections to maintain proper blood sugar. 

Treatment with lupus medications, such as corticosteroids or azathioprine, reduces inflammation and, as a consequence, reduces damage to the pancreas as well as other organs. 

However, some of the medications for lupus can have poor interactions with diabetes, with corticosteroids causing weight gain and prednisone leading to worse insulin resistance – and, as a consequence, worse diabetes! It is important to make sure that your medicine regimen is safe for both conditions.

A Lupus Warrior’s Takeaway

If you start feeling symptoms of pancreatitis, it is worth getting checked out as soon as possible. This is because not only can the issues have serious consequences, but the symptoms of pancreatitis can also be symptoms of more urgent and serious conditions. Leaving possible pancreatitis for too long can, potentially lead to complications like scarring as the damage gets worse.

In other words, get checked out if you can, and make sure that your treatment team is aware of any diabetes or potential pancreas issues.

A few years ago, Christine Miserandino wrote a post on the blog “But you Don’t Look Sick” called “The Spoon Theory”. Using spoons from a diner, she explained to a close friend what it’s like to have lupus or other chronic illnesses. You can read the post for yourself here.

Let’s dive into the key takeaways of the spoon theory of energy management:

• You start out with only so many “spoons” per day, and have to manage them carefully.
• It’s the little things that cost spoons, like standing up, reaching, picking out clothes, and so on that really drain the day. Many people, even people who understand the idea of limited energy, don’t realize that these little things cost spoons at all.
• Some activities and sub-activities cost a good amount of spoons, but are so necessary that people with lupus have to do them anyway and base other activities around them.
• Using more spoons than what you have means that you are borrowing against your spoons the next day and your health.

Note: If the terminology of “spoon”s is throwing you off, try thinking of them as “energy points” or something similar. Coins, puzzle pieces, or pieces from a sheet of paper may work too — whatever works for you and your friends.

Tips for Managing Energy

#Lupuswarriors are in the trenches every day, trying to manage their energy and take care of yourself and others. You have to be both warriors, fighting through the day, and generals, planning the whole campaign along with your lupus treatment team. It’s not easy, but you can do it – you do it every day.

A lot of how you manage lupus and your energy levels is unique to you, and each #Lupuswarrior has their own battle strategies.  There are a few basic things that you can do, however, to help maximize your spoons.

Take Medications as Prescribed

Lupus medications come with a variety of unpleasant side effects and can seem like they aren’t worth the hassle. Some of these side effects can even cost you spoons. However, the prescriptions that make up a lupus treatment plan can be crucial to decrease organ involvement and maintain long-term health. Not taking medications will lead to less spoons in the future, which means fewer spoons to use on things that you need to do, and more flare ups.

Don’t Skip Meals

Your body needs energy, and many lupus medications need to be taken with food. However, nausea, pain, fatigue, and the gastointestinal problems that can come with lupus may get in the way of your daily meals. You may be tempted to skip a meal, but you shouldn’t – you will be paying for it later. Keep simple foods on hand like soups and small snacks, and try to keep some energy available to eat. 

Take Vitamins and Minerals

Eating is important, but just as important is making sure that you eat right. Giving your body all the nutrition it needs (and avoiding foods such as garlic that can lead to flares) is important to maximizing your health and energy. However, #Lupuswarriors can find it difficult to eat a full set of nutritionally balanced meals. Taking multivitamins, calcium tablets, and vitamin D supplements can ensure that you get what you need even when you don’t have the spoons for eating more than the basics.

Don’t Overdo It

When you’re having a good day, it’s tempting to try and take on the world. Symptoms come and go, or medications take effect. Or, you find a great new strategy that makes you feel like you can finally do all of the things on your to-do list. Remember to take things one step at a time. It’s not easy to hold yourself back, but if you do too much at once, you could set yourself back. Be patient, take breaks, and go easy on yourself – you’ll get to where you want to go if you pace yourself.

Plan Ahead

#Lupuswarriors are also generals. Plan out your day as if you were fighting a war – what do you have to do that day? What do you want to do today? How are you feeling? What’s the weather like? How much do you think you can do today? When can you take breaks? Which tasks truly must be accomplished, and what can wait until tomorrow? The answer to each of these questions will be different for each person with lupus day-to-day, and how you plan this out may take on different forms. Try a flowchart or a scheduler for easy guidance, and keep an eye on your condition throughout the day to change the plan as needed.

Let Other People Help

Delegation is an important part of any #Lupuswarriors arsenal. Learning to ask for help is an important part of your care journey. If you need something to get done, but you don’t have the energy to do it in whole, do what you can and have someone else do part of it for you. Or all of it. The key to getting support is asking.

Taking Care of You

Most of all, though, have reasonable expectations for yourself, get through your day, and do what you need to do.

Reading blogs and posts by other people with lupus and other chronic illnesses can help keep things in perspective and offers a morale boost.

The But You Don’t Look Sick blog has inspiring and insightful posts by guest posters with many different chronic diseases. “Spooniechat” is a twitter chat for people with chronic illnesses, and is a great place to share spoon-conserving advice.

If you want to learn more about fatigue and managing your energy with lupus, our article here discusses it in-depth.

Nearly 50% of people with lupus experience some sort of brain or nervous system-related symptom related to their lupus. Despite how common it is, and despite the medical world being aware of these symptoms for over a century. Neurological symptoms are the least talked about and least understood product of lupus.

Neuropsychiatric symptoms can include:

• Headaches
• Depression
• Anxiety
• Brain Fog
• Fatigue
• Sensory issues (hearing, sight, smell)
• Balance issues (vertigo)
• Seizures

And even the severe breaks with reality known as psychosis. You can read more about the neuropsychiatric symptoms of lupus, here.

These neuropsychiatric symptoms, when present, usually show up along with other Systemic Lupus Erythematosus (SLE) symptoms at onset or diagnosis of the disease. They don’t generally have characteristics unique to SLE. Which makes it unclear whether the cause is SLE or if it is a comorbid or co-existing issue. Because of this ambiguity, it is difficult to properly diagnose and treat neuropsychiatric symptoms of lupus as a part of lupus. Plus, everyone’s lupus is different, and not everyone has these mental symptoms, or may only have a few. 

Although it is sometimes referred to as “Neuropsychiatric Lupus Erythematosus,” there do not seem to be patterns of symptoms that could indicate a specific neuropsychiatric form of lupus, like lupus nephritis or cutaneous lupus. However, neuropsychiatric involvement is clearly linked to SLE.

Although thinking about the neuropsychiatric symptoms of lupus can be frightening, it is important to know that they can happen. Frequently misdiagnosed or brushed aside in favor of the more physical symptoms of lupus. Many people with neuropsychiatric lupus feel like they are “crazy,” and have to endure this alone. Instead, there are many people experiencing the same or similar symptoms. And we know enough about it to work through it together.

What are the Risk Factors for Neuropsychiatric Lupus?

Although everyone’s lupus experience is different, people with more severe lupus – as measured by the SLEDAI scale – had a higher rate of neuropsychiatric symptoms. In a paper looking at 1121 registered patients, where 429 (38.3%) of these people had neuropsychiatric issues, researchers found that tests revealed a link between severe lupus symptoms, positive antiphospholipid antibody tests, and no anti-dsDNA antibodies at diagnosis. ANA tests were not very good at detecting neuropsychiatric lupus, however.

Interestingly, these people also had fewer years of education under their belt. Which is also linked to worse economic situations, higher levels of stress, and worse health overall.

How does Neuropsychiatric Lupus Happen?

Part of the reason for brain and nervous system symptoms in SLE is the effect of lupus on the circulatory system. Patients with primary neuropsychiatric lupus (very severe cases) were found via magnetic resonance imaging (MRI and DS_MRI) to have lower blood flow in their brains, compared to people with secondary (less severe) neuropsychiatric symptoms and people without reported brain symptoms. When blood flow is restricted or impeded by the cardiovascular symptoms of lupus. The brain doesn’t get enough oxygen to function at its full capacity. This can lead to fatigue, headaches, sensory issues, and even the seizures sometimes seen with lupus.

SLE can also affect the brain directly. Normally, the brain and spine are protected by a barrier that restricts the entry of immune system cells. For some people, this barrier – the blood brain barrier – is more permeable and lets these cells through.

In people with lupus who have permeable or damaged blood brain barriers. Autoimmune cells (the immune system cells involved with lupus) can enter the brain and cause damage or inflammation. Resulting in these neuropsychiatric symptoms.

Grey matter and white matter, types of neurons found in the brain, are, indeed, different in people with neuropsychiatric lupus. Other neurological structures in the brain show damage or weakening – atrophy. The amount of this damage is directly related to the severity of lupus symptoms and to how quickly the neuropsychiatric symptoms show up after diagnosis.

However, a review of the brain structures of mice modeling (imitating) neuropsychiatric lupus did not reveal damage to the blood brain barrier.  Many cases of neuropsychiatric lupus may be side effects of damage or inflammation throughout the body. Or, the symptoms may actually come from a combination of factors including other organ and brain issues caused by SLE – it isn’t easy to determine.

And, in the end, most people with lupus are, understandably, more concerned with managing the symptoms affecting their immediate lives, over determining the root causes.

Treating Neuropsychiatric Lupus

No therapies specific to neuropsychiatric lupus exist, and few therapies have been tested on people with severe neuropsychiatric symptoms specifically. In fact, they are often excluded from clinical trials due to complications.

Fortunately, there is evidence that controlling the symptoms through therapy and medications and reducing lupus activity through normal lupus medications is effective in treating the neuropsychiatric aspect of SLE. Reducing inflammation in particular helps the brain and the blood brain barrier to heal and become less permeable.

However, it should be noted that antimalarial medications, which are often used for lupus, seem to have an additional protective effect on the brain.

Overall, when caught early, typically due to good communication between patient and treatment team. The prognosis for neuropsychiatric SLE can be good.

T cells are a special type of white blood cell that come from the thymus known as a lymphocyte. White blood cells work to protect the body. They seek-out and destroy threats to the body. In particular, T cells specialize in attacking pathogens that use the body’s own cells to multiply.

Common targets of T cells include:

• viruses
• bacteria
• tumors

How do T cells properly identify, flag, and destroy the correct cells? Cells that have been damaged in some way have a distinct chemistry and a protein signal on the other membrane. T cells

However, T cells will sometimes make a mistake and attack the body’s own healthy cells. Usually, other immune system cells reign them in and destroy these faulty T cells before they cause problems. This process is known as regulation. 

But, for people with autoimmune diseases, including systemic lupus erythematosus (SLE) and lupus nephritis (LN), the regulatory cells fail. This allows T cells to go rogue and attack the body, causing the symptoms of lupus.

T cells vs B cells

The immune system actually has many different types of cells that work to protect the body. Each one specializes in a specific type of defense. Two types of cells called “Lymphocytes” have been linked directly to lupus:

B-Cells, are involved with investigating and recognizing invaders (known as antigens). When they identify a threat, they produce B-cell activating factor, a known sign of lupus.

T-Cells are more like the strike teams because they mark and kill problem cells. They also cause B cells to transform into plasma cells, which attack invaders with enzymes and toxins. Furthermore, they possess another important role: clean up. 

T cells come in several forms:

• Helper
• Regulatory
• Cytotoxic
• Memory

Helper T Cells

Helper T Cells are the scouts. They mark cells to be destroyed and trigger the immune responses of other cells. Helpers are incredibly important. When problems occur with these T cells, invaders slip through unnoticed and the body can’t fight disease effectively. 

As a safeguard against triggering the immune response unnecessarily and to keep the response targeted, Helpers need to receive two signals in order to activate the immune response.

1. The first signal comes from an attached antigen
2. The second comes from an activated cell immune system cell
   • Once activated, Helpers are part of the chain reaction known as the immune response

Once the antigen has been eliminated and the first signal goes away, the Helpers deactivate. This stops the chain reaction and the immune response dies down. 

When Helper T cells react to auto-antigens (proteins produced by your own cells), they are actually working properly. The problems that result in lupus occur elsewhere in the system, where Helpers that would react to auto antigens are usually destroyed. You can read more about ANA, a type of auto-antigen, here.

Regulatory T Cells

The thymus in most healthy individuals actually destroys autoimmune lymphocytes. This is extra important for T cells because there is a thin line between attacking rogue cells and healthy cells. T cells also have their own policing force: Regulatory T Cells or Tregs (or Regulators.)

Tregs are still somewhat of a mystery. But, most researchers believe that they act as an added level of security, limiting the immune response and also specifically preventing T cells from targeting the body’s own healthy cells. In fact, they specifically target and hold back T cells that are targeting the body’s antigens.

Or, rather, they are supposed to. Tor people with lupus and other autoimmune diseases, there is some evidence that their Tregs are faulty (either due to damage or due to genetic factors) and unable to do their job. Not only are they not able to stop T cells from targeting healthy cells, but they are also permitting a constant (or flaring) state of inflammation. That’s the bad news.

The good news is that T regs can be targeted with medications with promising effects. You can read more about genetic factors related to lupus here.

Cytoxic T Cells

Cytotoxic T Cells are also known as “Killer T Cells” and they do exactly that. They are extremely efficient assassins, directly killing infected or compromised cells. They do this through various means:

• Cytokine secretion
  • The killer cell spews poison at the infected or cancerous cell. It breaks down viruses and prevents the cell from multiplying or performing any of the functions that it needs to do to survive.
• Cytotoxic Granules
  • These tiny beads are made up of enzymes that break into the cell and break down the virus’s production factories in the cell. They also trigger the cell’s self-destruct sequence, also known as apoptosis or cell death. 
• Fas/FasL Interactions
  • Cytotoxic T cells have a protein called FasL on their surface. It binds to the Fas receptor on the target cell. This causes changes in the cell’s membrane that pulls several signaling proteins together, triggering apoptosis. 

Interestingly, the Killer T cells are very good at only attacking the cells that they are supposed to. All of these methods are targeted and minimize damage to cells nearby.

Killer T cells are also involved in cleanup. Once no more compromised cells remain, they attack each other (usually through the Fas/FasL method). All Killer and Helper cells that were involved in the infection are disposed of. This stops the inflammation response and prevents healthy cells from being attacked by rogue Killer T cells. 

Again, in autoimmune diseases, this isn’t the issue. The problem arises because the regulatory T cells don’t stop the Helper cells from flagging more targets.

There is one type of T cell that the cytotoxic T cells do not kill: the memory T cells. 

Memory T Cells

Memory T cells, as the name implies, are the immune systems “memory.” They allow the body to recognize antigens that it has encountered before.

They “remember” antigens they have encountered previously by having a specific receptor on their exterior. If they find an antigen they recognize, they set off the immune response faster than non-memory T cells (also known as “naive” T cells). Memory T cells let the body protect itself quickly from diseases that once caused it problems. In fact, memory T cells and other immune memory cells allow vaccines to work – vaccines work like target practice that let the body create the appropriate memory cells.

The problem arises when the Memory T cells remember antigens that are harmless (as in allergies) or auto antigens (as in autoimmune disease.)

T Cells and Lupus

Research has made it clear that there is a link between systemic lupus erythematosus and T cells, particularly faulty regulatory T cells. Poorly regulated T cells are known to attack organs and neurons throughout the body. This causes the many symptoms of lupus and other autoimmune diseases, (including brain fog).

 According to LupusResearch.org, the more we understand about how these T cells work, the closer we come to harnessing T cells in treating lupus and other autoimmune diseases. Studies have shown benefits of altering T cells through treatment with CAR (Chimeric Antigen Receptor) therapy.

This therapy involves T cells (called CAR-T cells) that have been genetically engineered to produce receptors for the antigens that self-targeting cells produce. In this case, the B cells responsible for sending the T cells into a frenzy against the body’s healthy cells. It holds a lot of promise. In studies in mice, CAR-T cells had a long lasting effect, and even made memory T cells after they were no longer in the body. This means that the T cells flagged and killed off the problematic cells on their own. The mice even appeared to enter disease remission! 

One of the advantages of this kind of approach is that it could be very specific to lupus. Plus, it does not have some of the other risks associated with immune system suppressing drugs.

Current treatment status

Recently, the main focus of clinical trials involving CAR-T cells is attacking cancers, particularly blood cancers. Use of CAR-T for lupus is fairly new, but researchers are very excited about it’s potential.

Systemic lupus erythematosus, or SLE, is the most common type of lupus. SLE is usually what people mean when they just say “lupus”. It is an autoimmune disease that has a broad spectrum of intensity, ranging from mild symptoms, to serious organ issues. SLE has acute (short-term and intense) and chronic (long term and constant) symptoms.

Chances are, if you have SLE, you experience a variety of symptoms that fall under both categories. You can read more about SLE and its symptoms here.

 

A Strategic Approach to Lupus Management

The goal of clinical care is to identify the most appropriate treatment for a given patient. Researchers have developed a model which “posits that manifestations of SLE can be divided into 2 broad categories,” termed Type 1 and Type 2.

Lupus Type 1 SLE and lupus Type 2 are different subsets – types – of SLE  symptoms. It is possible for a person to experience both types. They are classified according to their symptom profiles, but also have biological differences. Your clinician can refine their treatment approach as particular medications lead to better results depending on type.

Type 1 causes the most tissue damage. It involves more immune system activity that actively attacks the internal organs. While Type 1 can quiet down and resemble remission, it can also flare up into painful, debilitating events.

Type 2 presents with less immune system activity and less organ damage. However, people with Type 2 SLE experience high levels of pain, fatigue, and more constant symptoms. Type 2 can come and go, and also have flares, but it usually ‘simmers’ at a lower intensity, but more constant state. These Type 2 concerns should be prioritized and treated by clinicians. Though, studies have shown that managing organ damage is often a rheumatologist’s primary concern.

Type 1 Lupus and Lupus Nephritis

Type 1 SLE is heavily associated with organ damage, and that includes the kidneys. The inflammation happens in the nephrons, the part of the kidney that is in contact with the bloodstream. The kidneys filter out waste products and keeping a good balance of salts and water in the blood. In SLE and lupus nephritis, the immune system misidentifies and attacks healthy tissues of the kidneys.

Lupus nephritis is distinct from SLE. However, the inflammation and subsequent organ damage caused by SLE leads to lupus nephritis. Although Type 2 SLE can lead to a lot of generalized inflammation in the body that could trigger lupus nephritis, this direct damage to the kidneys by Type 1 SLE appears to be a more frequent trigger.

Different Antibodies, Different Symptoms

One of the primary differences between the two types of lupus is the presence of a specific type of antinuclear antibody. Antinuclear antibodies (“ANA”)mark proteins found inside a cell’s nucleus (the “control center” of the cell). This sends the immune system to attack otherwise healthy cells. Normally, antibodies tag harmful pathogens, such as bacteria and viruses. But in autoimmune conditions such as lupus, ANAs set the body against itself. These types of antibodies are detected by a series of tests called ANA tests, which you can read more about here.

The special ANA that differentiates Type 1 and Type 2 lupus is Anti-dsDNA. Anti-dsDNA tags and attacks DNA strands. It is found in about 30% of people with SLE.

When it attaches to DNA, it may begin or contribute to chronic inflammation, and increased levels of anti-dsDNA may herald a return of disease. Several tests, including the enzyme-linked immunosorbent assay (ELISA), the Crithidia luciliae immunofluorescence test, and radioimmunoassay tests, can detect it.

 

Anti-dsDNA Antibodies

These anti-dsDNA antibodies are a major factor in organ damage (particularly of the kidneys) and  serositis. Researchers often find them in structures associated with (and inside) the kidney. This makes it very likely that they are the antibodies responsible for causing the damage. Add this to the fact that 2-30% of patients with SLE test negative for these antibodies, and there is a very compelling case for anti-dsDNA antibodies being involved in Type 1 SLE, but not necessarily Type 2.

 

Anti-RNP Antibodies

In comparison, anti-RNP antibodies are ANAs that react to RNA. RNA acts as a messenger, carrying the instructions for protein synthesis. Anti-RNP antibodies are generally associated with skin manifestations, as in cutaneous lupus, though whether they are associated with chronic disease is less known. However, the fact that there appear to be two different antibody profiles – the antibodies that are in play in each case – make it very likely that anti-RNPs may be a part of Type 2 SLE.

However, Anti-dsDNA antibodies frequently respond to immunosuppressant drugs, which shut down the immune system to prevent severe symptoms.

Strategically Treating Symptoms

Lupus Type 1

The etiology of lupus Type 1 is autoimmunity (inflammations-based which can lead to organ damage). Immunosuppressants and corticosteroids treat the biological factors related to Type 1.

These biological factors result in symptoms like:

• nephritis
• malar rash
• inflammatory arthritis
• mouth sores
• pleuritic chest pain
• cutaneous rashes
• serositis
• alopecia
• ILD (shrinking lung)
• vasculitis

 

Lupus Type 2

The etiology for Type 2 is noninflammatory. As such, these symptoms will not respond to standard immunosuppression.

Type 2 lupus patients are more likely to be prescribed analgesics (for pain), antidepressants, and lifestyle strategies (including sleep hygiene and exercise) to battle symptoms.

 Common Type 2 symptoms include:

• depression
• fatigue
• memory loss
• anxiety
• sleep disturbances
• brain fog
• cognitive disfunction
• pain

 

A Lupus Warrior’s Takeaway

Aside from differences in treatment options, what does it matter what type you have? Understanding the type of SLE you have can help predict what issues you are more likely to face in the future:

• People with Type 1 SLE will have to be on the lookout for signs of organ failure. Proactive monitoring helps protect the kidneys. Catching organ damage early is essential for limiting overall damage. It also underscores the importance of certain medication options.
• People with Type 2 SLE benefit from knowing that the symptoms are going to be more continuous. These symptoms, especially fatigue and pain, are both difficult to explain and severely impact day-to-day life. Many people write these symptoms off or try to “power through”. But, a lupus diagnosis can be a helpful step towards active strategies to reduce symptoms and chronic inflammation. You will also be more aware of new symptoms manifesting for different periods of time. And, will be better able to track them, figure out flare triggers, and report them to your lupus treatment team.

Hormones are chemicals that different cells in the body use to communicate with each other. By communicating, cells are able to work together to perform the many tasks that our bodies need to function. The body regulates everything from mood, to metabolism, to the immune system’s response with hormones.

One example of the important role hormones play in the body’s regulation is insulin. Insulin allows cells to absorb glucose and helps the body regulate blood sugar levels. When the body does not respond properly to it, it can result in diabetes.

Interestingly, there are also naturally occurring steroids in the body that are also a type of hormone. Based on the body’s receptors, they have been classified into five groups: glucocorticoids, mineralocorticoids, androgens, oestrogens, and progestogens. In the form of corticosteroids, are a major part of lupus treatment, and you can read more about it here.

Hormone Levels and Roles

Hormone levels are essentially consistent from one person to another. A person’s environment, mental state, and health can cause fluctuations

However, the family of hormones that control sexual function, reproduction, and development are different between the sexes. These hormones include:

• estradiol
• estrogen
• testosterone
• progesterone

The same hormone can fill many different roles, triggering different responses depending on the cell. The “sex hormones” are responsible for sex differentiation and reproductive behaviors. They also control a wide range of effects throughout the body. One of these effects is immune system regulation.

It is well-documented that sex-related hormones are related to systemic lupus erythematosus (SLE). Some researchers think that sex hormone levels, and in particular high levels of the hormone estrogen, might be the reason that females have higher rates of SLE and other autoimmune disease.

That said, hormones are not the only factor in SLE. The effects of hormones on the body are too complicated for treating immune system dysfunction with hormone therapy to be considered at this time. Genetics, and sex differences in chromosome expression, is thought to play a greater role than hormone levels in most cases of SLE. 

What is the Relationship Between Hormones and Lupus?

One potential explanation for sex differences and SLE is the varying levels of sex hormones in the body. In particular, the ratio of particular hormones to one another may affect how immune cells develop and mature. And, which immune cells the body gets rid of.

B cells are a class of immune system cell that targets and marks cells for destruction. This happens at “checkpoints” in the body, including before cells are released. This process ensures the eradication of intruders like bacteria and virus-infected cells.

Estrogen and prolactin (sex hormones associated with female reproduction and development) are also involved in protecting B cells from destruction. Higher levels of these hormones can allow more B cells to circulate in the body. Next, the increased level of B cells can lead to an immune response, and may trigger symptoms of lupus.

Estrogen Treatments

Estrogen is known to activate or encourage the activity of T cells. These cells seek out and destroy pathogens that use the body’s own cells to multiply, such as viruses, some bacteria, and tumors. T cells are a major component of lupus-related damage and symptoms, and you can read more about them, here.

When mice were treated with an estrogen antagonist (a type of medication which prevents estrogen from binding to receptors on cells) they had decreased rates of disease and milder symptoms.

One potential explanation for the reason women (females) develop SLE more frequently than men (males) is because they have more estrogen. This can be linked to two causes: 1) higher production levels of estrogen; and 2) higher levels of the natural conversion process of testosterone to estrogen (known as aromatase).

Before converting to estrogen, testosterone first becomes estradiol. A 2003 review on hormones in SLE noted estradiol levels are higher in people with SLE. This difference in estradiol levels was not found in males, though it should be noted that there are not as many large studies on SLE in men. This implies that there is a higher-than-normal conversion of testosterone to estrogen. Plus, it might amplify estrogen’s effect in the body further.

 

Testosterone Treatments

Testosterone, a male sex hormone, is known to suppress the immune system. Conversely, estrogen and other hormones in the same family push the immune system to produce and react to antibodies, leading to immune responses.

People with lupus may be more sensitive to the estrogen in their bodies due to genetics. This allows it to trigger responses more easily, and potentially allows it to accidentally target the body’s own cells. This is supported by the finding that, if a woman’s ovaries are working sub-optimally and producing low levels of estrogen, she also has a lowered risk of lupus.

Conversely, oral contraceptives, estrogen treatments, and ovulation induction as a part of fertility treatments have been known to trigger flares. When testosterone is administered, it is linked to reduced lupus symptoms.

However, estrogen also influences the development of T-cells in the organ called the thymus. The hormone is involved in activating CD3-T cells and producing cytokines. Notably, estrogen treatment can lower thymus activity, but low levels of estrogen can also lower thymus activity. This implies that normal estrogen activity is needed to keep the thymus and the immune system working at a healthy level. It is also necessary for the destruction and survival of cancer cells, a vital function of the immune system, as well.

The immune system is a complex and multi-organ system. It’s a complex organization that we don’t fully understand. Both disease-specific and general research have dramatically increased the human understanding of the system, including the various types of cells and pathways that trigger the body’s defenses. Still, we don’t know all of the reasons why it sometimes turns on itself, causing autoimmune diseases.

Below is an overview of the immune system and what does in our body, from head to toe.

 

The First Line of Defense

… Or, more accurately, from skin to bone. The first line of defense that our bodies have against infection is our skin. Layers of dead cells coated with oils and enzymes from sebaceous glands act as a barrier between us and the outside world. There are also bacteria, yeasts, and even viruses on our skin that keep less-welcome microorganisms from taking residence, protecting us further.

Our eyes, mouth, nose, anus, and genitals act like gateways for pathogens to get through this protective layer, but there are gatekeepers:

• Tears wash out the eyes and contain salts, water, and antimicrobial enzymes that keep them clean
• Mucous in the nose catch small particles and pathogens and helps the nose and lungs remove them (either out of the body, through coughs and sneezes or into the stomach, by swallowing)
• Stomach acid destroys swallowed pathogens
• Saliva and mouth-based bacteria have some anti-microbial properties 

We actually all have bacteria, viruses, and other microorganisms living inside us that help prevent infection. They help by taking resources away from potential pathogens and by creating anti-microbial chemicals that protect the body. Many of the bacteria living in our guts also help digest certain foods and provide vitamins essential to our health. The gut is very important to the immune system, and you can read more about it here. 

This is why hygiene is so important to health. Cleaning your skin (baths, showers, and hand-washing) and your mouth (brushing teeth) wash away a lot of pathogenic bacteria.

When pathogens do get through these defenses, they make their way into other organs or the bloodstream. This is when immune system is supposed to take action. 

The Inflammatory Response

Alongside our first-line defenses, our immune system has something called innate immunity. Innate immunity is our baseline ability to defeat invading microorganisms, even when we’ve never experienced them before.

This is usually a general and intense response. It is a part of the reason why people get sicker the first time they catch an illness.

High fevers, a runny nose, rashes, and other symptoms of sickness are the body putting forth a powerful and general inflammatory response. As the body experiences more diseases and builds up a repertoire of antibodies (that recognize the illness) it is better able to modulate its responses and fight illness more efficiently. This is called the “adaptive immune response.” Adaptive immunity involves T cells and B cells that specifically target the pathogen or the affected cells.

Put another way, when the body doesn’t recognize a pathogen, it mounts a generic, powerful response. But, when the body does recognize the invading pathogens, it responds by creating strategic antibodies designed to combat the specific threat.

The inflammatory response is a chain reaction of activity in the body that leads to an appropriate (or inappropriate) response to a pathogen. Fighting infection is a long and complex process, but in short it involves:

1. Antibodies patrolling the body recognize a pathogen or the skin or cells in muscle tissue are damaged. In either case, inflammatory particles are then released into the surrounding tissue.
2. These inflammatory particles – of which there are too many to name in a brief overview – affect the cells around them. The cells respond by causing them to release more inflammatory particles. 
3. What happens next depends on the particular particles and the damage involved, but eventually these inflammatory particles act as an alarm signal, triggering the immune system to act.
4. Other cells, such as lymphocytes, are sent to the area.
   • Fluid is often retained around the cells in the area, causing swelling.
   • Cells in the disturbed area may be triggered to produce more heat, creating a “fever.”
   • Blood vessels are expanded to allow the passage of immune system cells, reddening and warming the area.
   • Exactly what happens depends on the injury and the signaling particles that get released
5. In all cases, the body is set to a higher alert level overall, and more immune cells end up in circulation. These immune cells can activate in response to other pathogens or injuries.
6. After the threat is no longer detected by the body, the immune system ramps down the inflammatory response. Again, the signals involved depend on the response, but usually, the body returns to normal.

The Body’s Reaction

The body’s reaction, and thus the specifics of the immune response, vary depending on what the body is fighting. When it’s a virus, T-cells are deployed, and cause the infected cells to destroy themselves. When it’s a wound or an irritant on the skin, platelets and regeneration-inducing immune system particles are sent to the area to fight off any invaders while the skin heals. If there is a bacterial infection, the whole body will turn up the heat production to “cook” the bacteria – as in a fever.  

The body figures out the correct response to a situation because it is built into the immune response. Or because it ‘learns’ the way that it is supposed to handle a pathogen or signal. This learning process is called “immunization.” Although we know parts of it, other aspects of it are unclear because of the complexity of the system. The body becomes immunized when it is exposed to a pathogen or substance. Vaccines immunize the body by exposing it to a less potent version of a disease or to the antigens that would be found in the disease. But it can happen naturally as well.

Instead of resetting completely, it saves antibodies of particular pathogens to a sort of library. This allows the body to recognize and be better able to fight off infections. This is why second or third infections from the same source are less intense.

However, this is also how many allergies work. When the body develops antibodies to harmless and common substances, it marks them for attack and triggers an inappropriate inflammatory response. It is this inflammatory response that causes the damage and danger associated with allergies.

Autoimmune diseases are similar. In both cases, they are treated by medications that modulate the immune system.

Where do immune system cells come from?

There are many different types of immune system cells, but most come from the same place that our red blood cells come from: our bone marrow. Bone marrow is a region of soft tissue in the center of certain bones including:

• the sternum
• spinal vertebrae
• iliac bones (in the pelvis)
• ribs
• skull
• shoulder blades

Colloquially, many different types of immune system cells are called “white blood cells.” They are also known as leucocytes. These blobby cells prowl through both blood vessels and lymphatic vessels, seeking out pathogens.

There are many different types of white blood cells that are specialized for specific activities. Neutrophils tend to attack bacteria, while macrophages generally stick to patrolling for pathogens and cleaning up dead cells. Many, however, are more generalized. White blood cells can be found in lymphoid organs like the thymus and spleen, and will also be in the bone marrow and the lymph nodes.

Lymphocytes also are produced in the bone marrow. And often stay in the bone marrow (B-lymphocytes,) where they act as the memory of the immune system. B-Lymphocytes produce antibodies that recognize pathogens and alert the body to invasion. When lymphocytes travel to the thymus, they are stored and become T-lymphocytes. They patrol the bloodstream, seek out marked cells, destroy them, and alert the rest of the immune system to their presence. 

Antibodies are produced by leucocytes and lymphocytes, and act as both marker and destroyer, depending on the type. These remain present in the body as a part of the memory of the body. They are major factors in adaptive immunity – our body’s “trained” response to pathogens. Antibodies have one end, which is variable, and fits like a puzzle piece to proteins on the surface of pathogen cells. Or on the surface of the body’s cells infected with a virus. Once it does, the signal and marker molecules are unlocked. 

Internal Organs and the Immune System

Immune system cells are stored in different organs in the body. 

The thymus, a soft organ in the upper torso or neck, processes and stores T-lymphocytes, allowing the cells to finish maturing. The organ is at its largest in childhood and shrinks in adulthood. It also produces thymosin, a hormone that increases lymphocyte production. As a person grows older, the other organs pick up the slack and become more important to the immune response.

The spleen is a soft organ shaped like a glove and located near the stomach. It filters the bloodstream and acts as a source of spare red blood cells in case of injury. It also holds several lymphocytes, including T and B cells. The spleen is a common place for immune system cells to come into contact with pathogens in the bloodstream. It also finds and destroys defective red blood cells, refreshing the blood. It may have other immune regulation functions, too.

Lymph nodes are areas where immune system cells are stored and where lymphatic fluid flows through and is filtered. There is a whole system of lymph vessels that connect between the nodes and, separate from the bloodstream, transport the cells to where they need to go. The lymph nodes are located in the joints and in the neck, and swell up during injury and, especially, sickness. They can prevent pathogens and poison from traveling beyond the limbs.

Because of the complexity of the immune system and health in general, nearly every organ in the body plays some role in the immune response. (Interestingly, the brain and eye are protected from most immune responses.)

The Immune System & Lupus

The most common type of lupus is Systemic Lupus Erythematosus (SLE) and it is an autoimmune disease. Lupus occurs when the immune system attacks the body’s own cells instead of attacking just pathogens and virus-infected cells. Then, the system error that causes this can result in antibodies that target the body’s own cells. This ingrains the error into the immune system’s memory and ramping up the response and the damage it causes. These “auto-antibodies” can be detected by blood tests called ANA tests.

It’s still not clear what part of the immune system goes awry with lupus. T-cells and B-cells are potential culprits, and also potential targets for medications.

The immune system malfunctions associated with lupus may also be a general series of health issues caused by stress. Stress and anxiety are linked to physical and chemical changes in the brain and body that can affect the immune system and general health. It is a well-known phenomenon for stressful occupations and life events to be linked to flares. Or even the first diagnosable onset of lupus. Avoiding or reducing stressful situations can be difficult in this day and age. But treating anxiety and modulating stress can help with symptoms.

In either case, most medications for lupus involve the immune system and its components. Different medications affect different parts of the immune system or what stage of the inflammatory process that they target. This affects their side effects and effectiveness. You can read more about specific medications for lupus, here.

A Lupus Warrior’s Takeaway

Your immune system is important for both your symptoms and your overall health. It needs to strike a balance. Not so aggressive that it damages your body, but not so weakened that it lets in pathogens and makes you even more sick. Sometimes, though, lupus won’t let you make that choice, and you will need to take medications like immunosuppressants that suppress your immune system.  

But, your lifestyle can have a major impact on how you feel. Stay as healthy as possible through a healthy diet, regular exercise, plenty of sleep, and avoidance of what stresses you can. Probiotics are potentially useful for improving immune system health and lupus, and you can read more about what we know about probiotics and lupus here. 

Proper hygiene can help, too – preventing the pathogens from entering your body in the first place. This can help calm the immune system, too. You can read more about hygiene and lupus, here. 

In short, your immune system is a part of you. Take care of yourself, and your immune system will be taken care of along with it.