AUTOIMMUNE DISEASE IN WOMEN - THE FACTS

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AUTOIMMUNE DISEASE IN WOMEN - THE FACTS

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Autoimmune Disease

The term "autoimmune disease" refers to a varied group of more than 80

serious, chronic illnesses that involve almost every human organ system.

It includes diseases of the nervous, gastrointestinal, and endocrine

systems as well as skin and other connective tissues, eyes blood, and

blood vessel. In all of these diseases, the underlying problem is

similar--the body's immune system becomes misdirected, attacking the

very organs it was designed to protect.

Table I

Female:Male Ratios

in Autoimmune Diseases

Hashimoto's disease/hypothyroid itis 50:1

Systemic lupus erythematosus 9:1

Sjogren's syndrome 9:1

Antiphospholipid syndrome 9:1

Primary biliary cirrhosis 9:1

Mixed connective tissue disease 8:1

Chronic active hepatitis 8:1

Graves' disease/hyperthyroi ditis 7:1

Rheumatoid arthritis 4:1

Scleroderma 3:1

Myasthenia gravis 2:1

Multiple sclerosis 2:1

Chronic idiopathic thrombo-

cytopenic purpura 2:1

A WOMEN'S ISSUE

For reasons we do not understand, about 75 percent of autoimmune

diseases occur in women, most frequently during the childbearing years.

Table I(left) lists the female-to-male ratios in autoimmune diseases.

Hormones are thought to play a role, because some autoimmune illnesses

occur more frequently after menopause, others suddenly improve during

pregnancy, with flare-ups occurring after delivery, while still others

will get worse during pregnancy.

Autoimmune diseases also seem to have a genetic component, but,

mysteriously, they can cluster in families as different illnesses. For

example, a mother may have lupus erythematosus; her daughter, diabetes;

her grandmother, rheumatoid arthritis. Research is shedding light on

genetic as well as hormonal and environmental risk factors that

contribute to the causes of these diseases.

Individually, autoimmune diseases are not very common, with the

exception of thyroid disease, diabetes, and systemic lupus erythematosus

(SLE). However, taken as a whole, they represent the fourth-largest

cause of disability among women in the United States.

A NEED FOR KNOWLEDGE

Autoimmune diseases remain among the most poorly understood and poorly

recognized of any category of illnesses. Individual diseases range from

the benign to the severe. Symptoms vary widely, notably from one illness

to another, but even within the same disease. And because the diseases

affect multiple body systems, their symptoms are often misleading, which

hinders accurate diagnosis. To help women live longer, healthier lives,

a better understanding of these diseases is needed, as well as providing

early diagnosis and treatment.

MAJOR AUTOIMMUNE DISEASES

CONNECTIVE TISSUE DISEASES

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SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

An inflammation of the connective tissues, SLE can afflict every organ

system. It is up to nine times more common in women than men and strikes

black women three times as often as white women. The condition is

aggravated by sunlight.

Symptoms: Fever, weight loss, hair loss, moth and nose sores, malaise,

fatigue, seizures and symptoms of mental illness. Ninety percent of

patients experience joint inflammation similar to rheumatoid arthritis.

Fifty percent develop a classic "butterfly" rash on the nose and cheeks.

Raynaud's phenomenon (extreme sensitivity to cold in the hands and feet)

appears in about 20 percent of people with SLE.

Treatment: Anti-inflammatory drugs can help control arthritis symptoms;

skin lesions may respond to topical treatment such as corticosteroid

creams. Oral steroids, such as prednisone, are used for the systemic

symptoms. Wearing protective clothing and sunscreen when outdoors is

recommended.

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RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a systemic disorder in which immune cells attack

and inflame the membrane around joints. It also can affect the heart,

lungs, and eyes. Of the estimated 2.1 million Americans with rheumatoid

arthritis, approximately 1.5 million (71 percent) are women.

Symptoms: Inflamed and/or deformed joints, loss of strength, swelling,

pain.

Treatment: Rest and exercise; anti-inflammatory drugs when necessary.

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SYSTEMIC SCLEROSIS (SCLERODERMA)

Scleroderma is an activations of immune cells which produces scar tissue

in the skin, internal organs, and small blood vessels. It affects women

three times more often than men overall, but increases to a rate 15

times greater for women during childbearing years, and appears to be

more common among black women.

Symptoms: In most patients, the first symptoms are Raynaud's phenomenon

and swelling and puffiness of the fingers or hands. Skin thickening

follows a few months later. Other symptoms include skin ulcers on the

fingers, joint stiffness in the hands, pain , sore throat, and diarrhea.

Treatment: The drug D-penicillamine has been shown to decrease skin

thickening. Symptoms involving other organs such as the kidneys,

esophagus, intestines, and blood vessels are treated individually.

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SJOGREN'S SYNDROME

Sjogren's syndrome (also called Sjogren's disease) is a chronic, slowly

progressing inability to secrete saliva and tears. It can occur alone or

with rheumatoid arthritis, scleroderma, or systemic lupus erythematosus.

Nine out of 10 cases occur in women, most often at or around mid-life.

Symptoms: Dryness of the eyes and mouth, swollen neck glands, difficulty

swallowing or talking, unusual tastes or smells, thirst, tongue ulcers,

and severe dental caries.

Treatment: Interventions to keep the mouth and eyes moist include

drinking a lot of fluids and using eye drops, as well as good oral

hygiene and eye care.

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NEUROMUSCULAR DISEASES

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MULTIPLE SCLEROSIS (MS)

A disease of the central nervous system that usually first appears

between the ages of 20 and 40, and affects women twice as often as men.

MS is the leading cause of disability among young adults.

Symptoms: Numbness, weakness, tingling or paralysis in one or more

limbs, impaired vision and eye pain, tremor, lack of coordination or

unsteady gait and rapid involuntary eye movement. A history of at least

two episodes of a cluster of symptoms is necessary for a diagnosis of

MS. Because MS affects the central nervous system, symptoms may be

misdiagnosed as mental illness.

Treatment: The drug baclofen is used to suppress muscle spasticity, and

corticosteroids help reduce inflammation. Interferons also are being

used to treat this disease.

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MYASTHENIA GRAVIS

This is a chronic autoimmune disorder characterized by gradual muscle

weakness, often appearing first in the face.

Symptoms: Drooping eyelids, double vision, and difficulty breathing,

talking, chewing, and swallowing.

Treatment: The drug edrophonium along with daily rest periods can

improve muscle strength.

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GUILLAIN-BARRE SYNDROME

Guillain-Barre syndrome is an acute illness that causes severe nerve

damage. Two-thirds of all cases occur after a viral infection.

Symptoms: Tingling in the fingers and toes, general muscle weakness,

difficulty breathing, and, in severe cases, paralysis.

Treatment: Supportive care until the condition is stabilized, then

rehabilitation therapy combined with whirlpool baths to relieve pain and

facilitate retraining of movements. A process called plasmapheresis,

which removes plasma and nerve-damaging antibodies from the blood, is

used during the first few weeks after a severe attack and may improve

the chance of a full recovery.

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ENDOCRINE DISEASES

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HASHIMOTO'S THYROIDITIS

Hashimoto's Thyroiditis is a type of autoimmune disease in which the

immune system destroys the thyroid, the gland that helps set the rate of

metabolism. It attacks women 50 times more often than men.

Symptoms: Low levels of thyroid hormone cause mental and physical

slowing, greater sensitivity to cold, weight gain, coarsening of the

skin, and goiter (a swelling of the neck due to an enlarged thyroid gland).

Treatment: Thyroid hormone replacement therapy.

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GRAVES' DISEASE

Graves' disease is one of the most common autoimmune diseases, affecting

13 million people and targeting women seven times as often as men..

Patients with Graves' disease produce an excessive amount of thyroid

hormone.

Symptoms: Weight loss due to increased energy expenditure; increased

appetite, heart rate, and blood pressure; tremors, nervousness and

sweating; frequent bowel movements.

Treatment: Antithyroid drug therapy or removal of the thyroid gland

surgically or by radioiodine.

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INSULIN-DEPENDENT (TYPE 1) DIABETES

Type 1 diabetes is caused by too little insulin production in the

pancreas, and usually occurs in children and young adults, but it can

occur at any age.

Symptoms: Increased thirst, increased urination, weight loss, fatigue,

nausea, vomiting, frequent infections.

Treatment: Monitoring of diet and insulin.

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GASTROINTESTINAL DISEASES

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INFLAMMATORY BOWEL DISEASE

Inflammatory bowel disease describes two autoimmune disorder of the

small intestine--Crohn' s disease and ulcerative colitis.

Symptoms of Crohn's disease: Persistent diarrhea, abdominal pain, fever,

and general fatigue.

Symptoms of ulcerative colitis: Bloody diarrhea, pain, urgent bowel

movements, joint pains, and skin lesions.

In both diseases, there is a risk of significant weight loss and

malnutrition.

Treatment: Antidiarrheal pills or bulk formers for mild cases. For more

serious cases, anti-inflammatory drugs are effective. Corticosteroids

are reserved for acute flare-ups of these diseases. In some cases,

surgery may be required to remove obstructions or repair perforation of

the colon.

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OTHER AUTOIMMUNE DISEASES VASCULITIS SYNDROMES

This is a broad and heterogeneous group of diseases characterized by

inflammation and damage to the blood vessels, thought to be brought on

by an autoimmune response. Any type, size, and location of blood vessel

may be involved. Vasculitis may occur alone or in combination with other

diseases, and may be confined to one organ or involve several organ

systems.

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HEMATOLOGIC AUTOIMMUNE DISEASES

Blood also can be affected by autoimmune disorder. In autoimmune

hemolytic anemia, red blood cells are prematurely destroyed by

antibodies. Other autoimmune diseases of the blood include autoimmune

thrombocytopenic purpura and autoimmune neutropenia.

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AUTOIMMUNE SKIN DISEASES

The skin frequently gives the first sign that an autoimmune diseases is

present. In many of the diseases mentioned, the skin is only

peripherally involved, but in others, the skin is the primary site of

the disease. One of the foremost is psoriasis, a common skin disease

that results from a malfunction in the life cycle of skin cells. The

process of skin cell production that normally takes about a month is

speeded up to several days, resulting in a build-up of thick scales.

SUMMARY

Autoimmune diseases run the gamut from mild to disabling and potentially

life threatening. Nearly all affect women at far greater rates than men.

The question before the scientific community is "why?" We have come a

long way in the diagnosis and treatment of autoimmune disease. But more

work is needed, especially in the areas of discovering the causes and

developing more effective treatments and prevention strategies.

The U.S. Public Health Service's (PHS) Office on Women's Health in the

Department of Health and Human Services, was established to redress the

inequities in research, health services, and education that have placed

the health of American women at risk. Its mission is to direct,

stimulate, and coordinate women's health research, health care services,

and public and health care professional education and training across

the Public Health Service agencies and to collaborate with other

government organizations, foundations, private industry, consumer and

health care professional groups to advance women's health. The focal

point for women's health activities in the Department of Health and

Human Services, the PHS Office on Women's Health is working to improve

the health of American women in this decade and beyond into the 21st

century.

The programs and activities in autoimmune diseases of the PHS Office on

Women's Health, joined with initiatives and programs across the agencies

and office of the Department of Health and Human Services, are providing

a solid foundation from which to increase knowledge about autoimmune

disorders in women.

For more information on autoimmune diseases, contact:

American Autoimmune Related Diseases Association

15475 Gratiot Avenue

Detroit, MI 48205

Phone:

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