6 Signs of an Autoimmune Disease That Can Be Easy to Miss

Julia Sullivan
·11 min read

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Think of your immune system like a hardworking security team: Day and night, with zero breaks, it’s scanning for potentially dangerous intruders. And while you mindlessly scroll your social feeds and munch on chips, it might be waging a battle against harmful bacteria and viruses without you even realizing it. But those defenses can occasionally glitch and mistake the very things it’s designed to protect—your own bodily tissues—for foreign invaders. When this happens, you might have what’s called an autoimmune disease, Konstantin Balashov, MD, PhD, the director of the Boston Medical Center Multiple Sclerosis Center, tells SELF.

But accurately diagnosing this problem can be so tricky. There are more than 80 types of autoimmune diseases (also called disorders or conditions) that researchers know of, and, frustratingly, it can sometimes take years to figure out what’s going on. A big reason for this? There’s no single test that can easily confirm a diagnosis, so doctors often have to rely on other markers, like symptoms, to try to put the puzzle pieces together. But the list of possible symptoms associated with autoimmune diseases is enormous, and they can feel a bit vague or be easily mistaken for another health problem. Plus symptoms might pop up in a lot of different places (or even move around) in your body. They can also wax and wane, worsening during flare-ups and then subsiding into relatively calm periods—and even disappearing by the time you get in to see a doctor—before ramping up again.

Most autoimmune diseases are chronic conditions, meaning they don’t have a cure. However, they are usually very treatable; an effective medication plan, physical therapy, and certain surgical procedures can help slow down or prevent severe complications or even permanent damage down the road. That’s why seeing a doctor about your symptoms early on is so important. Here are six signs you might have an autoimmune disease.

1. You’re ridiculously fatigued or constantly feel like you’re coming down with the flu.

When you’ve got an infection, your body funnels a ton of your energy into fighting it off. This is why you might feel particularly drained if you have a cold, the flu, or some other bug. “Your body works so hard to build an inflammatory response to fight infections, but that inflammation itself can cause fatigue,” Roshini Rajapaksa, MD, a gastroenterologist who treats autoimmune disorders that affect the digestive system, like Crohn’s and celiac disease, says. And because most autoimmune conditions cause widespread and chronic inflammation, feeling persistently worn down is a symptom doctors tend to see across the board, Dr. Rajapaksa adds.

Though every person that Lindsay McAlpine, MD, a neurologist at the Yale School of Medicine, treats has varying descriptions of fatigue, she’s noticed a few common patterns in folks with autoimmune diseases. “You’ll often hear patients say that when they first get up in the morning they’re doing okay, and then in the afternoon they hit a wall,” she tells SELF. “Or somebody takes a 20-minute walk around the neighborhood with their dog, and then 12 to 24 hours later, they crash and can’t function for a day or two.”

There are lots of reasons why you might be tired all the time, but Dr. Rajapaksa likens autoimmune-related fatigue, in particular, to a deep, whole-body ache: “You feel it in your bones and muscles,” she describes. “It’s not like you just didn’t get enough sleep last night.” Dr. Rajapaksa understands this on a personal level: She has Hashimoto’s thyroiditis, an autoimmune condition that causes the body to attack healthy thyroid cells, and fatigue is a major issue for her. “When I had a toddler and a newborn, I found myself extremely exhausted all the time,” Dr. Rajapaksa recalls. She initially attributed that fatigue to parenthood, but when it didn’t dissipate as her kids got older, she knew something bigger was happening. “I can personally attest to the fact that fatigue with an autoimmune condition profoundly affects your ability to function,” she says.

It’s one of Jennifer Graves’s most frustrating symptoms too. The 41-year-old lives in Gilbert, Arizona, and has both multiple sclerosis (MS) and rheumatoid arthritis (RA). “[The fatigue] can get so bad that I have no other choice but to stop whatever I’m doing and rest,” she tells SELF. “I could be in the middle of grocery shopping and I have to go home and sleep.” (FYI: Research suggests that one in four people with an autoimmune disease develop another one, like Graves did.)

2. You have unexplained pain or swelling in your joints or muscles.

Again, a wonky immune system often goes after certain body parts, and for a lot of people that inflammation settles in certain joints, per Dr. Rajapaksa. RA symptoms, for example, are often symmetrical, so you might feel aches in your wrists, fingers, toes, knees, shoulders, elbows, or ankles on both sides of your body, as SELF has previously reported. And like fatigue, autoimmune-related joint pain can seriously affect your day-to-day life, per Dr. Rajapaksa—something Graves knows all too well. “My RA makes my joints super swollen, sometimes I can barely move,” she explains, noting that her shoulders are hot spots. “I can recall times the pain would be so horrific that I would need to roll up towels and put them in my armpits to ‘separate’ the shoulder joint and relieve pressure.”

A few other notable autoimmune conditions that can cause joint issues? Lupus (one type that attacks a bunch of different parts of the body rather than a certain area), psoriatic arthritis (which typically manifests alongside psoriasis, another autoimmune condition), and Sjögren’s syndrome (a condition that triggers inflammation in the glands that produce moisture in your eyes and mouth).

What’s more, Dr. McAlpine says that chronic muscle pain or weakness, particularly in the legs, can sometimes signal things like MS. Actor Jamie-Lynn Sigler, who has been open about living with the condition, used to have symptoms so severe that she could barely stand. “I had to try so hard to look like an able-bodied person that I could barely concentrate on the scene I was in,” Sigler previously told SELF. “I was getting away with surface-level performances because I was just worried about physically holding myself up and trying to walk normally.”

3. Rashes or other strange skin issues are popping up.

There could be any number of reasons for a weird itchy spot or sudden rash. Perhaps you encountered an irritating detergent or a tick out in the woods. Often, skin symptoms gradually disappear with time or treatment (say, you stopped using the detergent or got an antibiotic for said tick bite). But it’s important to point out that some skin conditions defined by rashes are also autoimmune diseases, Dr. Rajapaksa says. She notes psoriasis as a really common one; it causes skin cells to multiply way too quickly, resulting in scaly skin, often on the scalp, knees, or elbows.

In other autoimmune diseases, skin issues can be a secondary symptom. For example, lupus sometimes presents with a butterfly-shaped rash on the cheeks after immune cells in your skin react to UV light. The rash can also flare up for no reason at all. Even some gastrointestinal conditions can cause skin problems too. “With celiac disease, an intestinal autoimmune disorder, you can get a characteristic skin rash,” Dr. Rajapaksa explains. That’s because if you have the disorder, your immune system sees the gluten protein in wheat and other foods as an invader. So when you consume it, your immune system goes a bit haywire and attacks healthy parts of your body—and yep, that can include your skin. All of this spurs inflammation that might lead to well-known GI symptoms, like bloating, diarrhea, and constipation, but also itchy, blistery rashes on the elbows, knees, butt, scalp, or back.

4. Your gut is seriously struggling.

Nobody over the age of 15 is going to feel amazing after downing a Chili’s sampler plate with spicy margs, but recurring bowel problems can sometimes mean your immune system is going into attack mode on your digestive tract, Dr. Rajapaksa says. Again, this could be related to something like celiac disease—she notes that a big chunk of people don’t even realize they have it, mistaking constant constipation or diarrhea for normal bathroom pains.

Ulcerative colitis (UC), which causes chronic inflammation and sores (most often in the rectum and colon), and Crohn’s disease, which can affect any part of the intestines, are two other autoimmune-related biggies, per Dr. Rajapaksa. Both UC and Crohn’s are inflammatory bowel diseases that can cause debilitating fatigue, diarrhea, abdominal pain or cramping, bloody poop, and sometimes weight loss.

It’s important to note that a lot of things can cause gut problems (like said sampler plate and even irritable bowel syndrome, which isn’t autoimmune-related). But if you’re sprinting to the bathroom and it’s seriously messing with your quality of life, it’s worth flagging to a doc.

5. You’re having trouble processing information, you have recurring headaches, or your vision seems off.

According to Dr. McAlpine, when your immune system attacks your nervous system (as is the case with MS), it can cause some pretty unsettling neurological effects. You might feel a little foggy in general: Research shows that people with MS are more likely to have difficulty processing information and have a harder time remembering things. The condition can also make you prone to chronic migraine or frequent tension headaches, studies suggest. Non-neurological autoimmune diseases, like lupus, psoriasis, and rheumatoid arthritis, can also cause cognitive issues.

Another hot spot for autoimmune attacks is the eyes. If your vision starts to change suddenly or for seemingly no reason—particularly if it’s blurry or you’re seeing double—that’s a symptom to flag to your doctor, Dr. McAlpine says. Super dry eyes can signal something is wrong too: It’s something 66-year-old Eileen Bailey from Pottstown, Pennsylvania, experienced before she was diagnosed with Sjögren’s syndrome. “I had dry eyes and a dry mouth, but I just drank water and used eye drops. I didn’t connect it to a medical problem,” she tells SELF. But when Bailey would lift her arm, she’d often wince with pain. When she flagged this issue to a doctor, the connection to her other symptoms finally surfaced.

6. You experience any of these symptoms in an on-again, off-again way.

Beyond the constellation of symptoms, there’s often one major defining feature among a lot of autoimmune diseases, Dr. McAlpine says: flare-ups. It’s common to go through periods when you feel totally fine, and then have weeks or months with symptoms. “That relapsing-remitting pattern is common across a lot of [these diseases],” she says. For example, in a Crohn’s disease flare-up, you might suddenly get painful gastrointestinal issues (urgent bowel movements or cramps) that pop up for seemingly no reason at all. Meanwhile, if your autoimmune disease predominantly causes pain (like in RA), your joints might get inexplicably swollen or stiff even if you felt totally fine a few weeks prior.

Try to remember when your first flare-up might have happened too. Dr. McAlpine says a bacterial or viral infection can sometimes “trigger” an autoimmune reaction in some people, so it’s worth bringing up to your doctor if you’re trying to solidify a diagnosis: “It really depends on the specific disease, but the onset of symptoms within [several] weeks of a viral infection is always kind of a clue. We’ve diagnosed quite a bit of new autoimmune diseases after COVID-19, for example.” Researchers have noted this trend among other infections too, like Epstein-Barr (EBV), a super common virus that can sometimes lead to mono, and cytomegalovirus (CMV), which is particularly a concern for pregnant people and newborns, since it can be transmitted during gestation and while breastfeeding. (Both EBV and CMV are in the herpes family, similar to the virus that causes chicken pox.)

Dr. Rajapaksa says it’s important to seek out a health care provider any time you have symptoms that affect your ability to live your life. If they suspect an autoimmune disease could be at play, they will refer you to a specialist, like a rheumatologist, who can do more testing. “If you’re fatigued to the point where you’re having trouble going to work or going to school, or you have abdominal pain to the point you can’t eat properly or you’re losing weight, it’s better to err on the side of caution.” You might be told that you’re dealing with an issue that’ll pass soon, or you might learn something new about your health. Either way, a doc can give you clear direction on next steps—and if you do have an autoimmune disease, they’ll get you situated with treatment ASAP.

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Originally Appeared on SELF