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  • Autoimmune Disease and Women

    IMAGE Ann, a lawyer in San Francisco, had been to see her doctor, but felt frustrated. When she described her symptoms—tired all the time, weight loss without trying, and just not feeling "healthy"—her doctor said she needed to relax more, maybe take a vacation. The doctor shrugged off Ann's concerns, saying she was young and in her prime and that she had nothing to worry about.
    When Ann's symptoms worsened, she went to another doctor recommended by a friend and was diagnosed with lupus, an autoimmune disease. With the cause of her symptoms finally identified, she was able to begin a treatment plan that helped control the symptoms that were upsetting her life.

    Difficulty Getting Diagnosed

    The term autoimmune disease encompasses more than 80 different, serious chronic illnesses. Many are rare, but as a group they plague more than 20 million Americans.
    Ann's experience is not uncommon. The American Autoimmune Related Disease Association (AARDA) found that more than half of patients with autoimmune diseases had been labeled hypochondriacs or chronic complainers during the earlier stages of their illnesses. This may be due to the nature of the symptoms: they are vague, tend to come and go, and are often hard to describe. Additionally, autoimmune diseases tend to strike women during their childbearing years, when a woman typically looks healthy.
    Getting a correct diagnosis may be difficult in the beginning stages, but it is imperative. The inability to quickly identify an autoimmune disease can take a serious toll on a person, both physically and mentally.

    Finding the Connection

    Researchers do not know why more women suffer from autoimmune diseases. In fact, little is known about what causes autoimmune diseases. It appears that hormones may play a role. The involvement of hormones has been hypothesized because the expression of autoimmune diseases and their symptoms seems to be related to changes in hormone levels.
    "No study clearly states that hormones cause autoimmune diseases," says Virginia Ladd, president and founder of the AARDA, "but a connection between the two is evident. If you look at the number of diagnoses after puberty and before menopause, you see a much higher rate than before or after these events. Also, some diseases suddenly improve during pregnancy, with symptoms re-emerging after delivery, and others may get worse with pregnancy."
    "The research is in its infancy, and although the inter-relationship between hormones and autoimmune diseases is acknowledged, most aspects of this relationship are not clearly understood," Ladd explains.

    Searching for a Cause

    The immune system defends the body's health by fighting foreign invaders. The key to proper functioning of the immune system is its ability to distinguish "self" from "non-self" tissues. Autoimmune disorders occur when the control process is thrown out of whack and the immune system reacts to normal, self body tissue. The body actually attacks its own tissues and can destroy body tissues, change organ function, or cause abnormal organ growth.
    Genetics play a role in the development of the disease. Numerous genes are involved and work together to increase a person's susceptibility. You may inherit genes that make you more likely to get an autoimmune disease. A combination of genes and other factors can trigger an autoimmune disease to start.
    Autoimmune diseases tend to cluster in families. Interestingly, though, the clusters manifest as different autoimmune diseases: a mother may have diabetes; a daughter may have lupus; and a grandmother may have rheumatoid arthritis.
    Noel Rose, MD, PhD, a professor at Johns Hopkins University and expert in the field of autoimmune diseases, states in a paper presented at an AARDA conference that "genetic components represent something on the order of half of the risks. If you have a genetic predisposition to autoimmunity, you may have two or five times as much chance of developing autoimmunity as someone else."
    There appear to be agents in the environment that trigger the disease or exacerbate symptoms. These agents include:
    • Sunlight, which cannot only worsen the symptoms of lupus, but may also bring about the disease
    • Silica, which has been found to possibly induce scleroderma
    • Iodine, which may aggravate thyroid disease
    • Viral infections, which may bring on or heighten certain immune diseases
    • Stress and anxiety, which have been shown to increase the severity and frequency of some symptoms
    Although researchers believe there may be some association between autoimmune diseases and the environment, the relationship is not clear and much remains to be discovered.

    Managing Autoimmune Diseases

    Most autoimmune diseases are chronic and few can be cured. Treatment focuses on reducing the severity of the symptoms. In some cases, symptoms may be reduced with steroidal or other anti-inflammatory medicines. With severe diseases, it may be necessary to suppress the immune system with immunosuppressive medicines.
    Until effective treatment or preventive measures are discovered, experts say that learning to cope with the disease is the best strategy. Developing coping mechanisms can be challenging and even frightening. You may not only question your own ability to cope but also the ability of those around you.
    The AARDA highlights the following two areas on which to focus your coping efforts:

    Dealing With Your Doctor

    It is important to not be intimidated by the medical profession; your doctor is your partner. Ask questions and fully understand your individual condition and treatment plan. Be an active member in the development of your treatment plan. Never be afraid to get a second opinion.

    Dealing With Your Emotions

    Mentally, you can expect to feel several different emotions, and it may seem like a roller coaster. The way you handle the emotional cascade is personal—find the way that works for you. It may be helpful to enlist the support of those around you, remembering that you are not alone. In fact, many people find joining a support group very helpful. And, most importantly, give yourself and your family time to adjust, since chronic illnesses have many ups and downs and can be emotionally draining.

    RESOURCES

    American Autoimmune Related Disease Association http://www.aarda.org/

    Lupus Foundation of America http://www.lupus.org/

    CANADIAN RESOURCES

    Lupus Canada http://www.lupuscanada.org/

    Women's Health Matters http://www.womenshealthmatters.ca/

    References

    American Autoimmune Related Diseases Association website. Available at: http://www.aarda.org .

    Autoimmune Disease: Overview. Department of Health and Human Services. Womens Health.gov website. Available at: http://www.womenshealth.gov/faq/autoimmune-diseases.pdf. Updated April 2010. Accessed November 18, 2010.

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