autoimmune disease on the rise in canada: diabetes, arthritis, ms and ibd highlight concerning trend
autoimmune diseases are on the rise in canada, with some growing at alarming rates, causing a personal and economic burden on the country.
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canada has one of the highest rates of ms, with over 90,000 canadians affected by the disease.
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the term autoimmune disease is used to describe a condition in which immune system cells designed to rid the body of infection and disease target healthy cells by mistake. the first autoimmune disease signifier, autoantibodies, was identified in the 1940s, and since then, the prevalence rates of these types of diseases have risen significantly.
of course, some of that increase could be due to new discoveries and recognition of these diseases, but something more may also be at play due to the rise in the last few decades.
there are over 80 different types of autoimmune diseases, with the most commonly known being:
- type 1 diabetes
- multiple sclerosis (ms)
- rheumatoid arthritis (ra)
- lupus
- crohn’s disease
- psoriasis
- scleroderma
the rates of these diseases are, in some cases, continuously rising, with some growing at alarming rates. for example, canada has one of the highest rates of ms, with over 90,000 canadians affected by the disease. research shows that by 2031, canadians with ms will increase to just over 130,000.
dr. gauruv bose, a neurologist and associate scientist at the ottawa hospital, specializes in ms treatment and management and has seen the trend firsthand.
“it’s definitely something that we’re seeing in the healthcare system, and for conditions like multiple sclerosis, rates in canada are disproportionately higher than the whole world. we’re really one of the most prevalent countries for multiple sclerosis,” he said.
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other autoimmune diseases, including inflammatory bowel disease (ibd), are also rising. according to the crohn’s and colitis foundation, by 2035, the number of canadians living with ibd is expected to be roughly 1.1 per cent of the canadian population, up from 0.7 per cent in 2018.
dr. sanjay murthy, associate professor at the university of ottawa and gastroenterologist at the ottawa hospital, specializes in ibd and other gastrointestinal disorders. while murthy has seen a stabilization of new diagnosis of ibd, he has seen more children and older adults with ibd than ever before.
“in many established industrialized countries, including canada, the overall number of new ibd diagnoses each year has stabilized (although it continues to rise in children),” he said in an email to healthing. “whereas, the overall number of individuals living with ibd has continued to rise as a result of increasing life expectancy among individuals with ibd.”
in canada, this could mean that more people are documented as having ibd simply because the medications and treatment options are allowing them to live longer, thus increasing the overall number. however, dr. murthy has seen a significant increase in ibd in newly industrialized and developing countries as well.
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rising rates by autoimmune disease
when looking at autoimmune disease as an umbrella, estimates put the number of canadians with this type of affliction at roughly two million. if you break down the numbers into specific types, they will vary significantly because no two autoimmune diseases are alike, nor are the number of people affected. the most common types of autoimmune diseases (besides ms and ibd) and their rising rates in canada include:
type 1 diabetes
type 1 diabetes occurs when the pancreas doesn’t produce insulin, a hormone required to process and manage glucose levels in the blood. autoantibodies destroy cells in the pancreas tasked with encouraging insulin production, which is why it’s considered an autoimmune disease.
roughly 300,000 canadians are currently living with type 1 diabetes, and it’s estimated those numbers are increasing at a rate of 4.4 per cent each year. between the years 2000 and 2020, the incidence rates of type 1 diabetes grew by 34 per cent.
rheumatoid arthritis (ra)
rheumatoid arthritis is a type of inflammatory arthritis that develops when immune cells attack the joints and organs. approximately one per cent of canadians live with the disease.
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according to research conducted between 2001 and 2014, cases of ra nearly doubled in the country. while reports regarding future incidence estimates are scarce, studies find that the rates rose by a significant 27 per cent between 1990 and 2019.
lupus
according to lupus canada, roughly one in every 1,000 canadians has the disease. it is a chronic autoimmune condition driven by attacks on healthy cells and tissues in any part of the body, including tissues, vital organs, and blood vessels.
studies show that the prevalence rate of lupus in alberta doubled between 2000 and 2015, suggesting that the year-over-year growth of lupus is not slowing down.
psoriasis
psoriasis is an autoimmune disorder that attacks the skin cells. it causes various symptoms, including itchy and inflamed patches of skin. it is highly common and affects roughly one million canadians.
between 2008 and 2015, the incidence rate of psoriasis grew from 0.09 per cent to 0.15 per cent. the future prevalence data of psoriasis are scarce at best, with no estimates being available as of writing.
scleroderma
scleroderma is an autoimmune disease that affects the joints, tendons, ligaments, bones, muscles, and tissues. it is rarer than other types of autoimmune disease, and roughly 17,000 canadians are affected.
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scleroderma is more severe than other diseases that fit under the autoimmune umbrella, and 40 per cent of people who develop it will die in five or fewer years after being diagnosed. because of that, incidence rate increases are difficult to track.
since not all immune diseases are on the rise, or the data is insufficient enough to make a claim either way, the focus of rising rates is heavily placed on ibd, ms, type 1 diabetes, and ra.
theories surrounding the cause of autoimmune disease
while the cause of autoimmune disease isn’t well understood, risk factors have been outlined that can help people determine if they are more likely to develop one now or in the future. some risk factors include:
- side effects of medications, including those used for blood pressure and antibiotics
- genetic predisposition
- smoking
- currently having an autoimmune disease, as it increases the risk of developing another
- toxin exposure
- being female, as females make up the majority of people with autoimmune disease
- obesity
- viral infections
all these risk factors are part of the puzzle, but there may be more to it regarding specific types of autoimmune diseases. dr. murthy revealed that other theories surrounding the onset of autoimmune diseases, ibd specifically, have a lot to do with gut health and the inflammatory response.
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“the current theory is that ibd is caused by a combination of genetic susceptibility, gut microbial composition, the integrity of the gut lining, and maladaptive and exaggerated inflammatory response to gut bacteria,” he said.
while there are few prevention methods, dr. murthy also stated that diet plays a role in the onset of ibd and “fruits and vegetables may be protective against the development of ibd, whereas animal fat and sugar may increase the risk.”
given the high prevalence of the standardized western diet, which includes very few whole foods and high intakes of foods designed to promote inflammation in the body, the theory is not far off, even though, according to dr. murthy, “more research is required.”
along with diet, smoking is another well-known factor that can be especially harmful for people at risk or who already have ibd.
“there is a well-established association between cigarette smoking and crohn’s disease flares,” dr. murthy said.
diet may also play a role in the development of ms. one particular study, shared by dr. bose, found that vitamin d and omega-3 fatty acid status can both contribute to the disease.
“if you have low vitamin d levels, and once again you kind of get this idea that well, certain countries like usa, canada, and europe, for example, are a little bit further from the equator—so, maybe we get less vitamin d exposure than places like mexico or africa.”
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the study was conducted in boston and followed 25,000 people over five years to assess their vitamin d levels and their risk for autoimmune disease.
“at the end of the five-year follow-up, only the groups that were exposed to vitamin d had a 20 per cent reduced rate of developing autoimmune diseases, and that’s a vitamin,” dr. bose said, later continuing that the immune system and its interactions with cells “are mediated in some ways by cholesterols, and vitamin d is a fat.”
other recent research has found a link between viral infections and the onset of the disease. dr. bose is well-versed in the results and thinks that it is highly possible that one highly-common viral infection could be to blame for ms and rising rates.
the virus in question is epstein-barr, otherwise known as human herpesvirus 4. the virus is in as many as 95 per cent of adults across the globe, but due to its latent nature, many people are unaware they have it or when they contracted it. the study that dr. bose cited examined u.s. military professionals and their exposure to epstein-barr as it relates to ms risk.
“what they found was that people who did not have exposure to the epstein-barr virus were very unlikely to have ms,” he said. “however, the people who then converted to develop multiple sclerosis, essentially all of them, converted to eb positive within a year or two before that diagnosis first happened.”
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it’s not just simply the virus that is driving ms onset and the possible rising rates, but when the virus is contracted. people who are exposed to epstein-barr later in life, as is the case with people in europe, canada, and the usa, may be more likely to develop ms than those who had earlier exposure.
while research is ongoing in this area, the results paint a speculative picture based on the high rates of ms in those countries, including canada, and the later exposure to epstein-barr.
“you wonder about the timing of being exposed to this virus later in life as being a pretty convincing trigger for multiple sclerosis and other autoimmune disease,” dr. bose said.
since medical advances continue to make things easier for people who experience chronic disease to find out earlier, another theory suggests that the rates may not be rising, but rather the documentation of the disease due to more diagnostic availability.
“availability of these diagnostic tests is one of the main factors for why we’re getting higher rates of multiple sclerosis diagnosis,” dr. bose said. “perhaps at one point, there weren’t many treatments available for multiple sclerosis, so there was this hesitation (to seek out diagnostics and treatment).”
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economic impact of autoimmune diseases and future directions
while research continues to shed light on autoimmune diseases and their increasing numbers, the picture is yet to be revealed. the burden of these diseases on the canadian population will only continue to grow as the numbers do.
“a major change in the costs of caring for ibd has been the rising drug costs from the introduction and widespread use of expensive biologic and small molecule targeted therapies over the past two decades,” dr. murthy said. “drug costs now exceed all other costs associated with caring for ibd.”
as costs continue to rise to treat these diseases, and new medications are developed to help improve the quality of life for those with autoimmune diseases, more people with autoimmune diseases will live longer than ever before, which, while exceptionally good news for those who develop them, also puts a strain on the economic side of caring for chronic disease.
“it’s a very high burden on the population and the economics of the countries that they’re in,” said dr. bose.
as data continues to be collected and research goes into identifying the causes behind autoimmune disease, it’s more crucial than ever to assess your risk and try to reduce it as much as possible. autoimmune diseases are not a death sentence per se, but they can severely impact a person’s quality of life, as well as their wallet.
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as dr. murthy puts it, “societies will need to adapt to these rising costs in order to maintain a healthy and productive ibd population,” and the same can be said for all other autoimmune diseases in canada.
unfortunately, until they nail down a cause for each specific type or autoimmune disease as a whole, the numbers will likely continue to rise in populations more susceptible to autoimmune development.
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