What is the best holistic treatment approach for patients with overlapping autoimmune syndrome?

From the Guidelines

The best holistic treatment approach for patients with overlapping autoimmune syndrome involves a personalized, multidisciplinary strategy that addresses both conventional medical management and lifestyle modifications, with a focus on immunosuppressive medications, lifestyle changes, and stress management to improve morbidity, mortality, and quality of life. A rheumatologist should coordinate care, working with specialists relevant to the specific autoimmune conditions present, as suggested by the 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis 1. Conventional treatment typically includes immunosuppressive medications such as corticorticoids, disease-modifying antirheumatic drugs, or biologics, as seen in the management of autoimmune hepatitis and primary biliary cholangitis overlap syndrome, where ursodeoxycholic acid (UDCA) and corticosteroids are often used in combination 1.

Key Components of Holistic Treatment

• Immunomodulatory medications: such as prednisone (5-60mg daily), hydroxychloroquine (200-400mg daily), methotrexate (7.5-25mg weekly), or biologics like rituximab or TNF inhibitors, tailored to the specific conditions and severity.
• Lifestyle modifications: including an anti-inflammatory diet rich in omega-3 fatty acids, fruits, vegetables, and whole grains, while limiting processed foods, refined sugars, and potential trigger foods.
• Regular, moderate exercise: tailored to the patient's abilities to manage inflammation and maintain function.
• Stress management: through techniques like meditation, yoga, or cognitive behavioral therapy, as stress can trigger flares.
• Adequate sleep (7-9 hours nightly) and vitamin D supplementation (1000-2000 IU daily) to help regulate immune function.

Coordination of Care

A multidisciplinary approach, led by a rheumatologist, is essential for managing overlapping autoimmune syndromes, ensuring that all aspects of the patient's health are considered and addressed, as emphasized in the management of ankylosing spondylitis 1. This approach should prioritize the patient's quality of life, aiming to control symptoms, prevent progressive structural damage, and preserve function and social participation. The choice of treatment should be based on a shared decision between the patient and the healthcare provider, taking into account the latest evidence and guidelines, such as those for autoimmune hepatitis and cholestatic liver diseases 1.

From the Research

Overlapping Syndrome Autoimmune

• Overlapping syndrome autoimmune refers to the co-occurrence of two or more autoimmune diseases in an individual, which can lead to complex clinical presentations and treatment challenges 2.
• The treatment of overlap syndromes is guided by small observational studies, and there is a need for rigorous, quantitative synthesis of the data to evaluate the efficacy of available treatments 3.

Holistic Treatment Approach

• A holistic treatment approach for patients with overlapping autoimmune syndrome may involve a combination of conventional and alternative therapies, including lifestyle modifications, dietary changes, and stress management techniques.
• The use of disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, in combination with other therapies, may be effective in controlling disease activity and preventing joint damage in patients with rheumatoid arthritis and other autoimmune diseases 4, 5.
• Ursodeoxycholic acid (UDCA) and corticosteroids, with or without antimetabolites, may be used to treat autoimmune hepatitis-primary biliary cholangitis (AIH-PBC) overlap syndrome, with combination therapy potentially being superior to monotherapy 3.

Treatment Considerations

• The treatment of overlapping syndrome autoimmune should be individualized, taking into account the specific diseases involved, the severity of symptoms, and the patient's overall health status.
• A multidisciplinary approach, involving healthcare professionals from different specialties, may be necessary to manage the complex clinical presentations and treatment challenges associated with overlapping syndrome autoimmune.
• Further research is needed to elucidate the optimal treatments for overlapping syndrome autoimmune and to develop effective, holistic treatment approaches that address the physical, emotional, and psychological needs of patients with these conditions 6, 3.