Lifestyle changes may minimize ‘inflammatory cascade’ associated with autoimmune disease

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

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

“All of these factors impact how our patients respond to biologic medications,” he said.

Munoz additionally covered how “cross-talk” between the microbiome and these factors can impact patients on all types of rheumatology drugs. He added that genetic abnormalities may carry associations with the microbiome and lead to autoimmunity.

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

“Doctors are thinking about pharmacotherapeutics and lab results,” he said. “As nurses, I believe you have been [using integrative medicine] from the beginning.”

Balancing conventional and integrated approaches may be the key to optimizing patient outcomes, Munoz added.

“It is about healing the whole person, and not just a disease,” he said. “It is not just a joint count.”

That said, Munoz acknowledged that although many integrative medicine approaches have become more precise in recent years, they are “still a bit nebulous.” He sought to offer some deeper perspective on how these approaches could have a legitimate impact on patient outcomes.

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

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

Turning to genetic factors, Munoz zeroed in on the HLA-B27 system and its relationship to the microbiome as a potentially important factor for doctors and nurses to consider.

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

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

“If you have an anti-inflammatory diet, you are going to have less chance of dysbiosis of the gut,” he said.

This dysbiosis of the gut can be hugely consequential in patients at risk for autoimmune diseases, according to Munoz. He noted that when gut bacteria cross the epithelium and move into places where they do not belong, it can activate macrophages, including T cells and B cells.

“An inflammatory cascade has been set forth,” he said.

An important way to reduce this risk is with an anti-inflammatory diet. Munoz suggested that the Mediterranean nutrition pattern is a good place to start.

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

For the doctors in attendance, Munoz offered a final point tying together the conventional approaches with the integrated approaches.

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

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Rheumatology Nurses Society Annual Conference