The Spectrum of Autoimmune Disease Treatments

With multiple autoimmune disease treatment options available, learning about and deciding which treatment route to follow can be an overwhelming task. This article provides a high-level view of the most common treatment options, ranging from pharmaceutical agents requiring a doctor’s prescription to at-home treatments.

Doctors commonly prescribe immunosuppressants to reduce immune system activity and disease symptoms. Some treatments act on the whole immune system while others are targeted therapies.

Immunosuppressants may be taken in a pill form at home or may require a trip to the doctor if they are injected or infused intravenously (IV). Steroids (corticosteroids) are one of the most commonly prescribed immunosuppressants. These medications have a broad, non-specific effect on your body by reducing the activity of your white blood cells (immune cells) [1].

Biologic medications are a newer and rapidly evolving class of medications that provide targeted treatment for autoimmune diseases. This means they only interact with specific immune cells or immune-related proteins, called cytokines. For example, B cells are commonly targeted immune cells, and TNF (tumor necrosis factor) is a commonly targeted cytokine due to its role in promoting autoimmune disease. Generally, targeted therapies are better tolerated and provide better results for people living with an autoimmune disease [2, 3, 4]. 

Complementary and alternative medicine, CAM, are medical practices that sit outside of standard medical care. Acupuncture, cupping, therapeutic touch (Reiki), and biofeedback are examples of CAM that have been observed to alleviate autoimmune disease symptoms [5].

Acupuncture

Acupuncture is a popular alternative therapy that has been used for centuries. This therapy involves the insertion of tiny needles into your skin at strategic locations based on your symptoms. Although some people consider acupuncture lacking scientific rigor, a growing number of studies show that this alternative therapy is effective at relieving symptoms. Acupressure is the needle-free version of acupuncture, but the effectiveness of this method is less scientifically documented.

Studies using animal models with autoimmune disease show that acupuncture can reduce the biological factors that are causing disease symptoms, such as pain and inflammation. For example, an animal model of rheumatoid arthritis showed that acupuncture reduced inflammation and pain in affected joints and also changed the levels of inflammatory cytokines, the immune molecules that cause inflammation [6]. Another study showed that acupuncture had anti-inflammatory and pain-reducing effects, possibly due to acupuncture stopping a type of immune cell called macrophages from turning into pro-inflammatory cells in inflamed joints [7].

Studies on people living with autoimmune disease show that acupuncture is an effective alternative therapy for some people, but not everyone. How well acupuncture works seems to depend upon the disease symptom. For example, two studies reported minimal evidence for acupuncture relieving the fatigue that is associated with systemic lupus erythematosus [8, 9]. Acupuncture appears to be more effective for people with multiple sclerosis as it can reduce spasticity [10]. Not all autoimmune diseases have been well studied in terms of acupuncture, but studies show that for most people, acupuncture is a safe alternative therapy.

Cupping

Cupping, also called Hijama, is an ancient holistic practice for the prevention and treatment of a variety of diseases [11]. This practice, which has both early Egyptian and Chinese origins, uses special cups placed along specific regions of your skin to create suction that stimulates the flow of energy and blood. Wet cupping is a variation where a person’s skin is lightly punctured and blood is drawn out by suction. 

A growing body of research shows that cupping may improve circulation while reducing inflammation and pain associated with a variety of ailments. Activation of the immune system, an increase in nitric oxide, and changes in biomechanical properties of the skin are some of the ways that cupping may reduce pain and alleviate disease symptoms [12, 13].  

The few studies that have directly investigated the effects of cupping in autoimmune diseases have produced conflicting results. While a recent trial showed that cupping therapy improved autoimmune activity and thyroid hormone profiles in 13 patients with Hashimoto’s disease [14], a more broad literature review found that cupping increased rheumatic disease side effects, including joint pain [15]. A comprehensive analysis of the benefits of cupping across a variety of autoimmune diseases has not been performed.

Reiki

Reiki (therapeutic touch) is a non-invasive therapy described as an energy-healing technique that promotes relaxation and healing. Reiki is considered safe, but it is unclear if it can reduce symptoms of autoimmune disease. A 2015 literature review found that Reiki therapy may effectively reduce pain and anxiety [16], but this has not specifically been studied in people with autoimmune diseases. 

Biofeedback

Biofeedback is a technique that focuses on partly controlling body functions that aren’t generally thought about, such as heart rate and breathing. Biofeedback training can vary depending on health challenges and goals. As technology advancements have been incorporated into medicine, patients have been able to improve their quality of life. For example, a 2019 rheumatology study of 20 patients showed that the combination of virtual reality and biofeedback successfully helped reduce pain and anxiety [17]. 

Hydrotherapy

Hydrotherapy, also called aquatic therapy or spa therapy, is safe for most people. Although the long-term benefit of hydrotherapy is unknown, studies in people with multiple sclerosis [18] and rheumatoid arthritis [19] show that aquatic therapy can improve quality of life by reducing pain and boosting mood in people living with these autoimmune diseases. 

Chelation Therapy

Chelation therapy is a mainstream treatment for removing toxic levels of heavy metals such as mercury or lead in a person’s blood after overexposure. However, it is also an alternative, experimental therapy for people living with autoimmune disease. Past studies have found that some multiple sclerosis patients have abnormal iron deposits in their brains, and chelation therapy was able to improve gait and balance [20]. Chelation therapy should only be used as a potential treatment for patients with autoimmune diseases that are linked to high levels of heavy metals; patients should be closely monitored during the chelation therapy process due to the risk of temporary side effects [20].

Self-care techniques that can be routinely performed at home are beneficial for anyone with an autoimmune disease. Research shows that mind-body interventions such as yoga and meditation can improve the perception of pain, joint flexibility, muscle strength, and disease activity in those living with autoimmune disease [21, 22]. Some researchers believe that mind-body interventions can also help overcome the psychosomatic component of disease [23].  

While self-care techniques are likely to improve quality of life, they have not been shown to improve autoimmune disease activity. A 2019 literature review analyzed 15 controlled studies of non-pharmacological interventions (education, relaxation exercises such as meditation, and performance exercises) with lupus patients. The review found that the interventions improved pain, fatigue, and quality of life. However, none of the studies, which ranged from 5 – 52 weeks, reported an improvement in disease activity [24].

Many people turn to nutrition-based treatments — homeopathy, herbal products, dietary supplements — as traditional herbal and nutritional approaches are being explored in the context of modern science [25]. While many supplements are being investigated, vitamin D and curcumin are two of the best-studied supplements in the context of autoimmune disease. 

Curcumin, a polyphenolic compound, helps regulate the cytokines that cause inflammatory signals in autoimmune diseases [26]. A systematic review of all studies about the efficacy of pure curcumin concluded that curcumin may have a variety of biological mechanisms. One of the human studies included in this review found that curcumin improved morning stiffness,  joint stiffness, and walking time in people living with rheumatoid arthritis [27].

There is also strong evidence for the use of vitamin D to support proper immune system function. Vitamin D has a broad range of functions in immunity, including supporting gut health and immune cell functions. Low vitamin D levels are seen in people living with multiple sclerosis or systemic lupus erythematosus, and vitamin D levels may impact disease activity [28]. Supplemental vitamin D may help reduce relapses, or relapse severity, in people with multiple sclerosis since lower serum levels of vitamin D are seen in patients during relapse [29].

The goal of most autoimmune disease treatments and interventions is to reduce symptoms and improve quality of life. Using a combination of approaches is likely to get the best results and finding the best combination that works for you may be a trial-and-error process. You can learn more about specific options by working with your physician and other medical specialists. As always, it’s important to speak with your doctor before starting a new treatment, to ensure it’s the right fit for you and complements your healthcare plan.