What is the "Autoimmune Tautology?"
Lingering questions asked and answered.
I thought I could combine all of my lingering questions and a synthesis of lessons learned about Multiple autoimmune syndrome into one post. Turns out, I was completely deluding myself. There is a lot to say about the questions that came up for me, so I will be breaking them down into individual posts. Thank you so much for your readership. I’m thrilled that you want to get into the weeds of autoimmune disease research with me. Please consider sharing this newsletter with other interested friends and family.
First off, I love saying au-to-immune tau-to-logy. It’s the alliteration of the three t’s and the fact that both words echo that central syllable “-to-”. These features are absolutely irresistible to a language lover like me. But where does the term come from and what does it mean?
I was first introduced to the term and concept in the 2012 study Introducing Polyautoimmunity: Secondary Autoimmune Diseases No Longer Exist by the Multiple autoimmune syndrome researcher Anaya, and his co-authors. Anaya went on to use the term routinely in subsequent studies, and I noticed that researchers unaffiliated with Anaya started to adopt the term more frequently in studies published in the last five years or so. I didn’t use the term in past posts because I wanted to better understand it and comprehensively explain it before adopting it in my writing and understanding of autoimmune disease.
The word “tautology” comes from the Greek tauto, meaning “the same,” and logos, meaning “idea,” in this context. The term autoimmune tautology means that all autoimmune disease originates from the same basic mechanisms. Shared characteristics among autoimmune diseases are listed in Table 1 below.
(From The autoimmune tautology, Anaya, 2012)
Part of what is so challenging for autoimmune symptom sufferers is the fracturing of medical care into different specialties that do not communicate or coordinate with each other. I have criticized the diagnostic process by body system here. The concept of autoimmune tautology is an inherent criticism of that system. It embraces a better paradigm for research, and clinical care, moving forward.
The process of compiling a comprehensive list of autoimmune disorders, confirmed what I already thought: autoimmune disease has been ad-hocked, mish-mashed, garbled and confused, by a naming and classification system devoid of discipline. And that has real world consequences. People suffer because of that confusion. Symptoms and lab results that don’t fit neatly into one diagnosis or another may be brushed off. Treatment may be delayed or withheld. People fall through the healthcare system’s yawning chasms.
If you can’t name it accurately, you can’t define it. If you can’t define it, you can’t study it. If you can’t study it, you can’t know its severity, prevalence, mechanism of action, and potential treatments. The autoimmune tautology is a critical and foundational building block for a disciplined and coherent lexicon for autoimmune disease. It has the potential to reorganize the cacophony of named autoimmune diseases into four interwoven disease-causing mechanisms: 1. sex predominance (is an autoimmune disease primarily found in genetic females, males, or equally in both?); 2. inherited gene variations that cause increased susceptibility; 3. gene triggering environmental exposures (infections, toxins, stress); 4. multiple destructive and interactive immune system processes. The autoimmune tautology helps me see a future where the diagnostic process is not based on body system and symptomatology. It’s based, instead, on patient sex, genetic variations in the patient’s exome, comprehensive screening for exposure to infections/toxins/stress, and comprehensive testing to determine immune system pathology. I believe this is the path forward for effective diagnostics, and most importantly, effective treatment.
Do you have any lingering questions about Multiple autoimmune syndrome? Please let me know in the comments below.
References
Anaya JM. The autoimmune tautology. Arthritis Res Ther. 2010;12(6):147. doi: 10.1186/ar3175. Epub 2010 Nov 9. PMID: 21092150; PMCID: PMC3046506.
Anaya JM. The diagnosis and clinical significance of polyautoimmunity. Autoimmun Rev. 2014 Apr-May;13(4-5):423-6. doi: 10.1016/j.autrev.2014.01.049. Epub 2014 Jan 11. PMID: 24424171.