The immune system is a normal part of the body that is designed to protect us from infections due to germs/viruses from the environment. The immune system also helps ward off cancer cell development in our bodies. When the immune system gets out of balance and starts attacking bodily tissues, this is called “autoimmunity.” In this situation, blood proteins called autoantibodies are produced that bind to and injure bodily tissues. Rheumatic diseases such as rheumatoid arthritis, lupus, dermatomyositis, and scleroderma are thought to be autoimmune diseases.
In a disease like rheumatoid arthritis, immune system abnormalities can attack the lining of the joints. This produces arthritis or inflammation in the joints. The term “inflammation” means a combination of pain, tenderness, swelling, and redness. The same type of immunological abnormalities that occur in the joint of a rheumatoid arthritis patient also can occur in the skin. As a result, skin lesions in patients with rheumatoid arthritis can reflect the state of activity of the immunological abnormalities inside of that patient.
In rheumatoid arthritis, one of the more common ways that the skin is affected is through inflammation in the walls of the blood vessels of the skin producing a condition called vasculitis. Since vasculitis also can occur in internal tissues, like nerves, in rheumatoid arthritis, it is necessary to treat patients having this type of skin problem with drugs by mouth or by vein that can dampen down the autoimmune abnormalities that are producing the inflammation in the blood vessel walls.
Drugs like the corticosteroids (“steroids”) suppress the immune response in a broad fashion and can be useful in a number of autoimmune diseases including the rheumatic diseases (corticosteroids are commonly referred to as “cortisone” type drugs). Corticosteroids like prednisone taken by mouth can suppress various manifestations of rheumatoid arthritis including the skin changes like vasculitis. However, long-term use of corticosteroids by mouth can produce troublesome and serious side effects.
Almost all of the rheumatic diseases . . . lupus, dermatomyositis, and scleroderma are thought to be conditions in which the immune system is not working properly.