Infections, Immune System and P?
from Guinn B.

Hi, Ed.  I love your website (mostly I just lurk on it).  I find it uplifting, although it's easy to get a little sad when reading of people's setbacks, because I know how that feels.  Don't we all!

The recent mailbag feature was intriguing because it raised the question of whether or not flakers have more likelihood of developing other autoimmune problems [Pregnancy & P Study], and you disclosed that you now have type 1 diabetes.  I am convinced there is a link to these ailments, one that medical science is only beginning to admit may exist.

Last year I resigned from a high-stress job, after a summertime upper respiratory infection — probably strep — left me with an extensive flare of guttate P on both arms and legs, and also on my torso, where I'd never had much of a problem.  The infection also left me feeling terribly depressed, and the very nice shrink I went to started me taking Paxil, which kept me from feeling suicidal but still didn't do anything to relieve the fatigue that had set in.  I mean, NOTHING seemed worth the effort of turning my hand over, not even music, which I adore.

In the meantime my derm started me on methotrexate, which only helped the slightest bit until his department head recommended body wrap and light treatments in addition to the MTX.  That cleared my torso and legs, but the daily expense of the parking downtown (the only place where a machine with the specified spectrum of light was available) had such an adverse effect on my dwindling bank account that it forced me to bail out of the treatment before my arms were cleared.  Still, I could live with that.

Finally, it dawned on me that maybe my ongoing fatigue had something to do with my family history of type 2 diabetes, so I got checked and, yep, that was another thing to add to my list.  Since starting on a diabetic diet, some of my energy has returned, but I'll probably need to take medication if I can't lower my blood sugar levels even more than by diet alone.  (So far I've resisted the dreaded e-word, Exercise, but I'll have to try that next, in hope of avoiding more meds.  A couch potato like me will almost try anything rather than get out of the house and walk.)

Has anybody else noticed a sudden wide range of symptoms like this after an infection?  There is a theory going around that most of what we now think of as genetic based disease, such as P, heart disease, diabetes, Crohn's, etc., are really caused by infection the way gastric ulcer has proven to be.  Any thoughts about this? -Guinn B.

*****

Ed’s Response:  All excellent questions and ones I can’t answer but can help you present.  I get the feeling — and that’s all it is because of my lack of direct or indirect knowledge — that most of what we know about the immune system has been learned recently and we’re still very much in a “discovery” phase.  I’m guessing this is because the immune system operates upon biochemistry that can only be demystified at the molecular level, and tools for doing that effectively are pretty new. 

One thing that we have believed for a long time, though, is that infection of any sort is Enemy Number One and the raison d’etre for our immune system.  Extrapolating from this, if infection ignites the action of our immune system it’s not unreasonable to assume it might also ignite that system’s errors or, if you would, misfirings, one of which is P.

A part of the problem in associating P with other auto-immune disorders is the apparently wide range of things that might trigger it.  Infection, surely — but perhaps not overwhelmingly.  Many of us, myself included, have no direct evidence of our P being started by any noticeable infection.  Indeed, the strep/guttate relationship between infection and P is almost the only infection/disorder relationship routinely written about in P literature.  That seems to be the case because so many people with sudden onset of guttate P report its coming on the heals of a serious strep infection.  (And another interesting possibility — but I mention it in parenthesis because I’ve just now thought of it — is that people with serious strep infections are likely to visit a doctor who, in turn, is likely to be apprised of a sudden onset of guttate P during or immediately after treatment for strep.  One wonders how many other kinds of infections might also trigger P but not send the victim to see a doctor?)

Finally, the hearsay case for infection triggering P is certainly compelling and associated with the biology of our autoimmune response, but to what do we attribute P’s tenacity once the infection is overcome?  For most of us, P is not something that comes and goes with infections — at least, not infections about which we are aware.  Maybe that’s the rub.  Are flakers and those who suffer from other autoimmune disorders experiencing a recalcitrant infection that eludes detection and isn’t effectively eradicated?  Heliobacter pylori is the organism, not discovered until the 1980s, which is believed to infect about half the human population and may lead to the development of gastritis and peptic ulcers.  There are several ways now to detect the infection; but exactly how it commences is still conjecture according to the most recent information at hand (many believe it is transmitted through feces, contaminated food or water, and generally unsanitary living conditions).

Wouldn’t it be ironic, Guinn, if now, while our eyes are focused on the search for a genetic cause of P, someone, somewhere, discovers a germ ... and subsequently an antibody that could be made into an antibiotic that cures us.

We would not complain, would we.  -Ed

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