Immunocompromised, Autoimmune diseases, and Adult JRA Remission: What it means for Social Distancing in the time of COVID-19

Definitions
Immunologic/immunology: the branch of science dealing with the components of the immune system, immunity from disease, the immune response, and immunologic techniques of analysis.

Immunocompromised: Having a weakened immune system. Patients who are immunocompromised have a reduced ability to fight infections and other diseases. This may be caused by certain diseases or conditions, such as AIDS, cancer, diabetes, malnutrition, and certain genetic disorders. It may also be caused by certain medicines or treatments, such as anticancer drugs, radiation therapy, and stem cell or organ transplant. Also called immunosuppressed.

Immunodeficient: inability to produce a normal complement of antibodies or immunologically sensitized T cells especially in response to specific antigens.

Autoimmune disease: a disease in which the body’s immune system attacks healthy cells.

  • 100+ autoimmune diseases. Most common: rheumatoid arthritis, lupus, celiacs, Sjörgens, multiple sclerosis, polymyalgia rheumatica, type 1 diabetes, irritable bowl disease, graves disease (too much thyroid hormone) hashimotis thyroiditis (thyroid production too slow)
    • Second highest cause of chronic illness
    • Can be caused by being genetically predisposed or by environmental triggers (such as contracting a virus), or a combination of both.
    • Autoimmunity persists and worsens (especailly untreated), and can affect any part of the body.

Autoimmune disorder: occurs when the body’s immune system attacks and destroys healthy body tissue by mistake. There are more than 80 types of autoimmune disorders. Generally there is no cure. (See: Autoimmune diseases)

Chronic (long-term): to be considered chronic symptoms must last more than six weeks.

Comorbidity: the simultaneous presence of two chronic diseases or conditions in a patient (common occurrence in autoimmune diseases)

Remission (for arthritis): (1.) Disease is no longer active (2.) Total absence of symptoms. (3). Some consider only occasional flare of joint tenderness or morning stiffness.

  • People who experience remission with RA do so while on medication.
  • Remission is not spontaneous. Usually if medication is stopped (especially suddenly), the disease can become more active.
  • Long term remission differs from regular remission.

Criteria for inactive disease includes:
(Defined by the Arthritis Foundation and the Childhood Arthritis and Rheumatology Research Alliance)

1.    NO joints with active arthritis.
2.    NO fever, rash, serositis (inflammation of tissues lining the lungs, heart, or other organs).
3.    NO active uveitis (inflammation of the eye).
4.    NORMAL C-reactive proteins and erythrocyte sedimentation rate (ESR).
5.    NO disease activity on the physician’s global assessment of disease activity.

To be considered for clinical remission, inactive disease must be a minimum of 6 continuous months, off medication. Clinical remission criteria is minimum 12 continuous months with inactive disease stopping all arthritis medications.