🧵 “Why did I get this disease, doctor?” — A thread.
“Sir, why me? What did I do wrong?”
This is the question I hear almost every week in my rheumatology clinic.
Let me tell you something honestly —
Autoimmune diseases don’t come from sin, weakness, or karma.
They come from biology.
A long story written in our genes.
Imagine your immune system as a loyal soldier.
It protects you from invaders — viruses, bacteria, injuries.
But sometimes, the soldier’s gun misfires.
The bullets hit your own body.
That’s autoimmunity.
Now, why does the gun misfire?
Because every soldier’s training manual — your DNA — is slightly different.
Some manuals carry old typos passed down from family.
Some pick up new smudges with time, stress, infections, or age.
If a single typo is powerful enough, it can flip the switch of inflammation by itself.
That’s what happens in monogenic diseases — like Familial Mediterranean Fever or DADA2.
One gene, one mistake, lifelong fire.
Often seen in children.
Sometimes, it’s not one culprit — it’s a gang.
Two or three small genetic changes, each harmless alone, but dangerous together.
They team up, confuse your immune sensors, and the system starts attacking its own.
That’s oligogenic or polygenic inheritance — common in lupus, RA, or scleroderma.
And sometimes, the story begins later in life.
A few immune cells quietly mutate with age
like rebels breaking away from command.
These “somatic” changes create rogue clones.
That’s how we discovered VEXAS syndrome — inflammation born from aging genes.
Genes aren’t destiny, though.
They’re like a loaded gun — environment pulls the trigger.
Infection, smoking, sunlight, stress, diet — they all whisper to your DNA,
changing how genes switch on and off.
That’s why two siblings with same risk may walk different paths.
The HLA genes — your immune ID cards — decide how your body recognizes “self.”
In some people, these IDs are misprinted,
and their own tissues look foreign to their immune system.
That’s the root of many diseases like rheumatoid arthritis and ankylosing spondylitis.
So, when you ask, “What did I do wrong?”
The real answer is: nothing.
You just happened to inherit a code that made your immunity slightly over-curious,
and then life’s environment gave it a little push.
The good news?
The same science that decoded your genes now helps us choose precise treatment —
from blocking IL-1 in autoinflammatory diseases
to targeting B-cells in lupus
to identifying VEXAS by a single mutated letter in DNA.
We’re not just treating symptoms anymore
we’re rewriting the story.
Autoimmune diseases are not punishments.
They are misprints in the poetry of immunity
and medicine is learning to edit them, one gene at a time.
— Dr. Illiasul Ibad
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