My understanding of Auto-inflammatory vs. Autoimmune: What is the difference?
Is Hidradenitis Suppurativa (HS) an auto-inflammatory or autoimmune disease? With current knowledge, HS is considered more of an auto-inflammatory illness. Officially and technically, it has not been classified as an autoimmune disease but patients and doctors alike will commonly use the “autoimmune” term as shorthand, causing confusion and leading to debate between the two. But “autoimmune” has technical requirements that current knowledge about HS does not meet. In this write-up I am going to explain the differences.
Auto-inflammatory vs. Autoimmune? They are both are complex and two classifications of immune-mediated disease. They are similar in that they both are a malfunction of the immune system, yet they differ in which part of the immune system is reacting. And understanding the difference may lead to proper, effective treatments and a better understanding of how your body works.
They share some characteristics: they start with the prefix “auto” to define a pathological process directed against self; they are immune-mediated diseases. They are characterized by activation of immune system seemingly without cause, and can eventually lead to chronic inflammation in individuals. Nevertheless, the specific effectors of the damage are different in the two groups of diseases: with auto-inflammatory the “innate” immune system causes inflammation, whereas in autoimmune the “acquired” or “adaptive” immune system is responsible for the inflammatory process. I will break it down even further.
Auto-Inflammatory
Auto-inflammatory diseases cause systemic inflammation due to problems in the “innate immune system.” During an auto-inflammatory flare, constant inflammation appears to occur automatically or “on its own” (instead of in response to invading germs or infection) affecting our joints, tissues, organs, every part of us. This auto-inflammation involves the nonspecific “innate immune system”[1] and occurs periodically in some people or chronically (constantly). This causes a disease flare with typical symptoms including fever, skin lesions, joint / muscle swelling and pain, body aches, gastrointestinal distress, overall malaise, and fatigue.[1]
Autoimmune
Autoimmune diseases involve the “acquired” or “adaptive” immune system, marked by the formation of antibodies that are mistakenly directed against specific parts of the body, leading the body to attack its own tissues as if it were fighting off invading pathogens. Both can show increased production of inflammatory cytokines (for example), however, auto-inflammatory illnesses (unlike classical autoimmune diseases) shows little to no evidence of specific adaptive immunity such as auto reactive T cells, lymphocytes and auto antibodies.
In a nutshell, auto-inflammatory is “innate” immune system where autoimmune is “adaptive” immune system. There are not a lot of diagnostic tools for auto-inflammatory other than elevated inflammation markers such as high white blood cell count, C Reactive Protein, etc. Because, unlike autoimmune, where ANA and antineutrophil are typically present, these antibodies are not present in blood work with auto-inflammatory illnesses (unless you have an autoimmune illness along with HS). The spectrum of auto-inflammatory disorders continues to expand and even some autoimmune illnesses are being reclassified in the auto-inflammatory category.
As I have mentioned, Hidradenitis Suppurativa is currently considered more of an auto-inflammatory illness. Researchers have searched for antibodies and other signs of adaptive immune system involvement, but have not found anything thus far. And this can also explain a lot for us, from our elevated inflammation blood markers, low-grade fevers, and widely reported fatigue.
With that said, never assume every ailment and every symptom is HS related. Always listen to your body and make sure other things have been ruled out, especially if it’s a new symptom(s) or an going debilitating symptom(s).
Research acknowledgements:NCBI.GOV, MDedge, Frontline Medical Communications Inc., and The autoinflammatory alliance.
Jacqueline Stevens
Congratulations!!! Great article!!!
Denise Panter-Fixsen
Thank you so very much.
Connie
Amazing article! I’m so proud of you!
Denise Panter-Fixsen
Thank you for your continued support.
Lekesha Nerem
Thank you for doing all that you do for hs suffers and more. You are my voice when I can’t speak
Denise Panter-Fixsen
Thank you so much sweetie.
Denise Panter-Fixsen
Thank you so much
Jennifer Lussier-Fontaine
My daughter is 13 and has lesions under her breast that are sometimes as big as a half dollar bill i feel awful. She cant get comfortable and is now on metformin. Any hime remideies to ease the pain or discomfort
Denise panter Fixsen
I’m so sorry to hear about your daughter. Xo Please feel free to join my group. I offer several home remedies/tips. Along with all the information you need to learn about HS. Link is below.
https://www.facebook.com/groups/2302568680069096
Ivan
Does this group available today? I can’t join
Debi
Where can you find doctors that are knowledgeable and efficient in treating this disease? My daughter is stage 3 and lives in Denver co
Denise Fixsen
Hi Debi, I’m so sorry about your daughter. You can check out our website Hsconnect.org. We have a h s dermatology list. And see if there is one in your area and or close to your area. I also encourage you to take a look around the website. As we offer a lot of tools and resources. ❤️
https://www.hsconnect.org/dermatologists
Denise ❤️
Amber Barber
Thank you for this article. I am one of the guilty parties you mention, and honestly had no idea that autoimmune and auto-inflammatory were two different things.
I stumbled across your article in search of a link to share with someone who referred to the immune system as the autoimmune system, (I’m a stickler for accuracy) but found a correction I need to apply to myself instead!
Your writing is excellent, and not just in your ability to reduce cumbersome, technical information into bite-sized factoids for layperson consumption. I hope you write about other things as well. You seem to be quite talented with words and writing to your audience.
Denise Fixsen
Hi Amber! Thank you for your kind words. I (we) have several different HS articles on our website, Hsconnect.org if you’re interested. I hope you have a wonderful day and please stay safe.
Denise Panter-Fixsen
Julie
3 of my 4 adult children struggle with this disease. It has been a part of our lives for over 15 yrs. This article gave me new insight regarding symptoms which I did not realize were part of the disorder.
Thank you for sharing this information. It was very enlightening.
LaShawn Thompson
I believe I have this condition. I first began to have what I called boils under my arms and in my groin area in my mid twenties. I’m now 54 and the boils/ nodules are a constant. I have them in my inner thigh, buttocks, and 2 yrs ago I had began to have them on both breasts. I am very self conscious about these sores and feel so unattractive. I’m so glad to have come upon your article. I am a diabetic, smoker??♀️, and have chronic fatigue along with anxiety and depression. I am on various pain medications. I am retired on federal disability and will try a second time to get approved for regular SSD. I will follow up with a dermatologist after I see a new Rheumatologist this coming Friday. I have been diagnosed with TLE from a skin biopsy 5 yrs ago and take hydrochlroquine twice daily. I’ve been on Methatrexate too. I also believe I have IBS because I have diarrhea frequently and notice blood and sometimes jelly like stools. I can have what I call diarrhea stools up to 6-8 times in one day. My doctor says I have GURD. I disagree. Anyway I can go on and on but now I know there is this disease and I will have my doctor to take a good look at this.
Thanks for reading
Molefi
Thanks you for this. It’s great to discover that I’m not alone.
Kim
Thank you, God Bless you for helping us. Most Drs. Diagnose wrong, until its Chronic.
Naturally me
Ain’t that the truth,nine years with no clue. I feel all of you in a way,living with H.S can be hard. especially when people don’t, can’t or won’t understand
Reta
Mayo Clinc web sight has what I think is a good overview.
Ramon
Great article!!! Thanks for the information I know I’m not alone on this battle called HS. Everything helps
Jessica Burkinshaw
Great article! Thanks for all the information. I’m 41 now and I feel like I’ve been having GS symptoms since I was 16.
Sarah
Thank you for the clarity – greatly appreciated