The increasing prevalence of autoimmunity and autoimmune diseases: an urgent call to action for improved understanding, diagnosis, treatment, and prevention

Abstract

Autoimmunity is characterized by self-reactive immune components and autoimmune disease by autoimmunity plus pathology. Both autoimmunity and autoimmune diseases are dramatically increasing in many parts of the world, likely as a result of changes in our exposures to environmental factors. Current evidence implicates the momentous alterations in our foods, xenobiotics, air pollution, infections, personal lifestyles, stress, and climate change as causes for these increases. Autoimmune diseases have a major impact on the individuals and families they affect, as well as on our society and healthcare costs, and current projections suggest they may soon take their place among the predominant medical disorders. This necessitates that we increase the scope and scale of our efforts, and coordinate our resources and studies, to understand autoimmune disease risk factors and pathogeneses and improve our diagnostic, therapeutic, and preventive approaches, as the costs of inaction will be profound and far greater without such investments.

Figure 1.

The estimated prevalence of antinuclear antibodies (ANA) in demographic groups in the US population over time. Colored circles represent the weighted estimate of ANA prevalence, and the colored lines show the 95% confidence interval for period 1 (1988–1991, blue), period 2 (1999–2004, yellow), and period 3 (2011–2012, red). P values for ANA time trend are displayed below each category and were derived from a logistic regression model that was adjusted for sex, age, and race/ethnicity (reprinted with permission [12]).

Figure 2.

Examples of the increasing prevalence of autoimmune diseases around the world over recent decades. The estimates for the time periods are connected by lines to visualize trends. Data sources are for: psoriasis in Canada [70]; type 1 diabetes in Denmark [71] and in the US [72]; celiac disease in the US [73]; multiple sclerosis in Canada [74]; primary biliary cirrhosis in the US [75]; all inflammatory bowel disease in the US [76]; Crohn’s disease and ulcerative colitis in the US [77]; and seropositive rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, Behçet’s disease, primary Sjogren’s syndrome, systemic clerosis, and myositis in Korea [68].

Figure 3.

Examples of increasing total direct medical costs of selected autoimmune diseases in Korea [68].