Autoimmune conditions, the prevalence of which has been increasing for decades, are complex conditions which are both challenging and costly to manage. Even with the advancement of biologic immune-suppressing pharmaceuticals, many patients still suffer from lingering symptoms, medication side effects, lack of guidance in participating in their own disease management, the persistent fear of relapse, and elevated risks for infectious or malignant conditions, not to mention the burden of worrying about covering the cost of these expensive medications. Specialty societies such as the American College of Rheumatology acknowledge that it is reasonable to consider tapering these medications for patients who achieve complete remission, and even advise as to the safest tapering schedules, however they offer no recommendations as to how to support patients in sustaining remission while tapering off and discontinuing these medications.
Meanwhile, lifestyle approaches targeting such immune-mediated inflammatory diseases (IMIDs) as Rheumatoid Arthritis, Psoriasis and Psoriatic Arthritis, have been shown to improve symptoms, especially approaches targeting gut health, given the predominant role of the GI tract in modulating immune function. (Eur. J. Immunology 2021. 51 798-810) Furthermore, the role of stress and HPA-axis dysfunction in IMIDs has been clearly established (The Role of Stress and the HPA-axis in Chronic Disease Management (Point Institute, 2020). Moderate physical activity, both aerobic and resistant, has been associated with a reduction in overall inflammatory burden and generally has favorable outcomes in patients with rheumatic autoimmune conditions. (Autoimmun Rev. 2012 Dec;12(2):218-24.) Sleep loss, both acute and chronic, is tied with a number of immune dysfunctions, mostly notably the increase in inflammatory processes. (Clin Dev Immunol. 2013;2013:801341.)
Utilizing a virtual model that leverages technology to allow for live as well as virtual care with continuous access via App to a health coach and curated content, we have developed a comprehensive integrative approach to these conditions. The unique aspects of our model include our ability to truly personalize care within specialist-built protocols based on a solid evidence base. This allows for provision of care at scale to a diverse patient base including those covered by commercial insurance as well as patients of community health centers with government-funded health plans.
We will describe our approach, experience and outcomes providing such care for diverse populations of patients with auto-immune diseases utilizing such a personalized, multi-disciplinary approach. Our protocol incorporates a strong focus on nutritional interventions (dietary as well as nutraceutical) targeting gut health, stress management, sleep optimization and physical activity encouragement relying on wearables for measurement of sympathetic nervous system tone, sleep quality and movement.
Our use of tech-enabled reporting back to patients showing the impact of participatory lifestyle interventions on sleep, measures of stress such as heart rate variability and biomarkers of inflammation helps to reinforce healthy behavior change.
While not every patient with an Autoimmune Disease is able to safely taper off of biologic medications, we will discuss our protocols for identifying likely candidates, reviewing risks and benefits as well as optimal monitoring required.
Learning Objectives:
- Recognize the role of gut health including the microbiome and gut barrier dysfunction, sleep optimization, physical activity, and HPA-axis dysfunction in Autoimmune Disease.
- Discover how truly personalized care can be delivered at scale to a diverse population by leveraging virtualization and technology.
- Discover approaches to taper patients safely off biologic medications while maintaining remission (when within scope or in an integrative approach), understanding the risks and benefits as well as monitoring needs.
