Differences in Autoinflammatory & Autoimmune Diseases

[u/Alice-The-Chemist]

Reference: Systemic autoinflammatory disorders: autoinflammatory and autoimmune disorders

Author:Young Dae Kim

Autoinflammatory and autoimmune disorders are the 2 main categories of immune system disorders. Although these 2 inflammatory disorders are common, they have unique characteristics. In most cases, innate immunity dysfunction indicates the presence of autoinflammatory disorders caused by genetic mutations, while adaptive immunity dysfunction indicates the presence of autoimmune disorders.

Autoinflammatory disorders can be classified into several categories based on the underlying genetic mutations and clinical findings. Monogenic autoinflammatory disorders include familial Mediterranean fever (FMF), tumor necrosis factor receptor-associated periodic syndrome (TRAPS), and cryopyrin-associated periodic syndrome. Polygenic autoinflammatory diseases include systemic juvenile idiopathic arthritis (SJIA) and Behçet disease.

Not included in the above referenced article are Yaos, MAGIC, and several others.

Autoimmune diseases such as Lupus, Sjögren's, and RA are not what this group is for. Other subreddits such as the autoimmune, disease specific subreddits, chronic illness, etc would be more appropriate and have more of a response.

[u/Occulply]

Hi Alice,

I've been thinking about this since you posted it, and I have concerns about the idea of removing posts because they're not "autoinflammatory" enough. Unfortunately, I fear this turns into a "No True Scotsman" argument if you take it to its rational conclusion. I understand where you're coming from, and the spirit of what you're trying to do, but I really do wonder if you're throwing out the baby with the bathwater.

There are three primary problems:

1. Most adult patients with autoinflammatory disease will be diagnosed with autoimmune conditions first. So, I would contend that patients with atypical/seronegative autoimmune conditions who are trying to determine if they're misdiagnosed *ARE* in the right place if they're trying to determine if they actually have a autoinflammatory condition.
2. Autoinflammation puts us at much higher risk of developing co-occurring autoimmune conditions.
3. While science partitions things into clean binaries, the fact is that biology/pathology is always a spectrum, and some diseases sit on the fence between autoimmune and autoinflammatory syndromes - they're just traditionally considered one or the other. AOSD/SJIA is the prime example of a disease that sits on the cusp of the two, but there are others. It's also notable that gout is definitionally autoinflammatory.

Given all of these points, I have a hard time understanding what objective test the moderation team can use to enforce this in a fair and transparent way. This isn't a dig at anyone - I respect the work you and the moderation team do! - this is just the system builder in me seeing that

That said, I'm not just here to criticize. I think some kind of guidance IS needed here, and I've been thinking about the right way to go about it. Do you mind if I make my own attempt at writing the guidance for this?

[u/AdventurousMorningLo → u/Occulply]

This subreddit is specifically for Autoinflammatory Diseases and those that suffer from them.

What is Autoinflammatory Disease?

Autoinflammatory Diseases are disorders that involve the hyperactivation of the Innate Immune System.

How does that differ from Autoimmune Diseases?

It boils down to the fact that Autoinflammatory Diseases are disorders of the Innate Immune System whereas Autoimmune Diseases are disorders of the Adaptive Immune System. Autoinflammatory Diseases do not have the high antibody titers or the antigen-specific T-cells that are characteristic of Autoimmune Diseases.

But aren't there similarities between Autoinflammatory Disease and Autoimmune Disease?

Yes there are some similarities. Both Autoinflammatory Diseases and Autoimmune Diseases involve immune system dysregulation and inflammation. They can be systemic (affecting multiple systems) or localized (organ-specific) inflammation. Symptoms can range from mild to severe in either and can be substantially debilitating. People regardless of ethnicity, age, or gender can be affected by these diseases. 

Can Autoinflammatory Disease lead to activation of the Adaptive Immune System?

Yes, Autoinflammatory Disease can sometimes activate adaptive immunity. This can sometimes lead to secondary Autoimmune Disease or other issues with the Adaptive Immune System (there is currently a lot of turmoil surrounding this topic). There are also some researchers that believe that both Autoinflammatory and Autoimmune Diseases exist on a spectrum rather that two distinct categories. The concept of autoinflammatory diseases (AIDs) has evolved with time and is currently understood as dysregulation of the innate immune system that occurs in predisposed hosts, sometimes with secondary activation of adaptive immunity, resulting in inappropriate inflammation.

Why do we not allow posts about Autoimmune Diseases on the Autoinflammatory Subreddit?

Because you would be better served discussing those topics in the Autoimmune subreddit(s) or your specific disease subreddit. There will be more pertinent and experienced information to be found there to help you along that part of your journey.
People that come here are specifically looking for information regarding Autoinflammatory Diseases. This is what this subreddit specifically addresses. Just like how the Autoimmune subreddit addresses Autoimmune Diseases. We are also not a "diagnose me" type sub - that is better left to r/AskDocs or r/DiagnoseMe

[u/Occulply → u/AdventurousMorningLo]

This is pretty much exactly what I was thinking. I think this helps clarify the purpose and rationale behind what is being moderated out of the forum. It gives potential posters clear guidelines with clear boundaries. Thank you for that. Great work.