Lifestyle changes can minimize the “inflammatory cascade” associated with autoimmune disease

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ORLANDO — Lifestyle modifications such as exercise and an anti-inflammatory diet can improve the well-being of patients being treated for autoimmune diseases, a presenter at the 2022 Society of Rheumatology Nurses Conference said.

George E. Munoz, MD, The medical director of American Arthritis and Rheumatology Associates and medical director of the Oasis Institute, in Miami, discussed how factors including lifestyle, immune balance, genetics, environmental triggers and autoimmunity can affect patients with autoimmune diseases. .

“It’s about curing the whole person, and not just a disease,” George E. Munoz, MD, he told attendees. “It’s not just a joint count.” Source: Adobe Stock

“All of these factors affect how our patients respond to biologics,” he said.

Munoz also covered how the “cross talk” between the microbiome and these factors can affect patients taking all types of rheumatology medications. He added that genetic abnormalities may have associations with the microbiome and lead to autoimmunity.

According to Muñoz, integrative medicine approaches such as diet, exercise, nutrition, contemplation, stress reduction, sleep enhancement, botanicals and nutraceuticals can have an impact on the general well-being of patients with these conditions.

“Physicians are thinking about drug therapy and lab results,” he said. “As nurses, I think they have been [using integrative medicine] From the beginning.”

Balancing conventional and integrative approaches may be the key to optimizing patient outcomes, Muñoz added.

“It’s about curing the whole person, and not just a disease,” he said. “It’s not just a joint count.”

That said, Muñoz acknowledged that while many approaches to integrative medicine have become more precise in recent years, “they’re still a bit fuzzy.” He tried to offer a deeper perspective on how these approaches might legitimately impact patient outcomes.

For example, he noted that sleep disturbances or increased stress can increase cytokine levels, leading to pro-inflammatory reactions.

“Sleep disturbance is a risk factor for cardiovascular disease or all-cause mortality,” he said.

Regarding genetic factors, Muñoz focused on the HLA-B27 system and its relationship to the microbiome as a potentially important factor for physicians and nurses to consider.

“Ask your patients if they have family members with psoriasis or IBD,” he said.

Obtaining this information and then testing for HLA-B27 may allow a physician to intervene before any arthritic or spondyloarthritic activity becomes apparent. This intervention may not necessarily take the form of pharmacotherapy, but integrative approaches to improve the microbiome and minimize inflammatory agents.

“If you have an anti-inflammatory diet, you will have less chance of gut dysbiosis,” he said.

This gut dysbiosis can have enormous consequences in patients at risk of autoimmune diseases, according to Muñoz. He noted that when gut bacteria cross the epithelium and move to places where they don’t belong, they can activate macrophages, including T cells and B cells.

“An inflammatory cascade has been unleashed,” he said.

An important way to reduce this risk is with an anti-inflammatory diet. Muñoz suggested that the Mediterranean nutrition pattern is a good starting point.

“A lot of fiber and color,” he said. “That’s what your microbiome wants to make it a happy microbiome.”

For attending physicians, Muñoz offered a final point that links conventional approaches with integrative approaches.

“Traditional therapeutic interventions may not work as well unless the patient follows all other areas of lifestyle improvement,” he said.