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Comment by francisofascii | Hacker News Reader

There is also a school of thought (don't know how prevalent) that many autoimmune cases are not autoimmune at all. And that the unidentified bacteria/virus/pollution etc. is still present or persisting, so the immune system is continually fighting that hidden pathogen rather than one's own normal cells. And so conventional autoimmune treatments that suppress the immune system are allowing to unidentified pathogen to persist.

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Strep is one of those pathogens being actively studied within this context by the PANS clinic at Stanford. It’s been shown to demonstrate “molecular mimicry” whereby its protein signature resembles various parts of our bodies (in the worst case)… with portions of the heart and brain (basal ganglia) occasionally being affected. I suspect there are other pathogens out there that can do the same, but who knows!

Couldn't you tell this apart by the kind of damage caused to one's own cells and what kind of antibodies are present? e.g. https://en.wikipedia.org/wiki/Antinuclear_antibody

Depends on the type and quality of the test. Serological tests can yield incorrect readings.

Ah ANA, the wonderful test that everyone orders and then shamefully consults rheumatology because no one knows how to interpret it[0]. Almost a rite of passage in medical training now.

I jest but I think these tests are still a bit of a mystery (as in why these autoantibodies are made and what their significance is) especially as some people with high titres have no symptoms and vice versa although there is an association.

I think what parent is alluding to is that the trigger for production may be an infection, even if the damage is mediated by one’s own immune system.

[0]for a chuckle this is a humorous but accurate depiction: https://twitter.com/DGlaucomflecken/status/13719013464131174...

And then try convincing your primary care doctor that an ANA test could be negative and you can still have lupus or any other autoimmune disease.

I keep being fascinated by how medicine is simultaneously things like "that death sentence is a minor inconvenience now" and others and things like... this

>although there is an association

A pretty big association I thought

Also what is there exactly to interpret? Or what would a good interpretation look like? I've been to a rheumatologist before and they didn't exactly explain.

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