Why Conventional Medicine Ignores Non-Specific Autoimmunity

Author: Jeffrey Wacks, MD

Consider the following patient: a 40-year-old female presents with chronic, severe multi-joint arthralgias. She states her knees, shoulders, and ankles are in a constant state of pain. Additionally, she is fatigued, depressed, and gaining weight despite a normal caloric intake. Labs are negative for Rheumatoid Arthritis. However, the patient has a positive anti-nuclear antibody (ANA) level and her C-reactive protein (CRP) level is severely elevated at 9.5 mg/L. Patient also states that her symptoms are exacerbated by intake of gluten, although Celiac Disease markers are negative.

What is the healthcare provider to do with this patient? If this patient is referred to Rheumatology, they are completely dismissed. Conventional Rheumatologists generally do not do anything with a positive ANA without any other positive autoantibodies. According to them, these patients do not have an autoimmune or rheumatologic issue. They say that a positive ANA by itself is too non-specific and essentially does not mean anything. There is a disease entity called Undifferentiated Connective Tissue Disease (UCTD) which technically could be diagnosed if a patient has symptoms and lab test results that suggest an autoimmune disease, but the results aren't specific enough to meet the criteria for a known autoimmune disease. If diagnosed with UCTD, this would potentially warrant a trial of hydroxychloroquine or methotrexate. However, we have never seen a patient be given this diagnosis. Thus, they are dismissed by Rheumatology. Additionally, most conventional primary care providers are not willing to prescribe these medications themselves, especially if it is explicitly rejected by Rheumatology.

Another possibility is to diagnose the patient with polyarticular osteoarthritis, prescribe NSAIDs, and possibly refer to Orthopedics. In our opinion, however, this is an inaccurate diagnosis. Because of the positive ANA, severely elevated CRP, clinical gluten sensitivity, and systemic metabolic dysfunction, it is likely that there is an immunological/rheumatologic component to the patients arthralgias. Thus, this strategy misses the target as well. 

So these patients are essentially ignored by conventional medicine. They receive no diagnosis, there is no specialist to send them to, and primary care providers feel it is outside their scope. 

What is the Solution?

In our opinion, there are 2 potential options to pursue to fix this problem.

Option #1 - Conventional Rheumatologists come up with a solution for non-specific autoimmunity. In science, and particularly in medicine, we need to be humbled by what we don't know and accept new information with an open mind when it is presented. The reality is that the immune system can potentially attack a limitless number of proteins in the body. Just because the patient does not test positive for the 2 things we test for (Rheumatoid Factor and anti-citrullinated peptide antibodies), that does not mean that the immune system is not attacking anything. Some testing companies have attempted to create panels that test for a variety of other markers (i.e., Vibrant Wellness Autoimmune Zoomer, AVISE testing); however, these tests are not generally ordered in conventional Rheumatology at this time. But non-specific autoimmunity is a huge problem and we need to spend more energy figuring out what to do with these patients.

Option #2 - Send all patients with non-specific autoimmunity to a Functional Medicine provider. These patients are classic Functional Medicine patients because it is the archetypal example of a patient who is not properly served by the conventional system, who is then forced to seek answers elsewhere. But instead of making the patient go through the pain and suffering of figuring out that path for themselves, why not just refer them directly to a Functional Medicine provider? Isn't that better than nothing? In Functional Medicine, it does not matter that the patient does not have a formal diagnosis. Immune system dysfunction is a core imbalance that we deal with all the time. Even though we cannot say exactly "what" it is, we can still explain "why" it is happening. In patients with non-specific autoimmunity, we talk a lot about gastrointestinal inflammation, food sensitivities, overall metabolic dysfunction, oxidative stress, and hormone imbalance as being intricately connected with immunologic function. There is also a greater appreciation that the toxicity in our food and environment plays a big role as well.