Autoimmune Disease in Women

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AUTOIMMUNE DISEASE IN WOMEN - THE FACTS

Autoimmune DiseaseThe 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 IFemale:Male Ratios in Autoimmune Diseases

Hashimoto's disease/hypothyroiditis

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/hyperthyroiditis

7:1

Rheumatoid arthritis

4:1

Scleroderma

3:1

Myasthenia gravis

2:1

Multiple sclerosis

2:1

Chronic idiopathic thrombo-cytopenic purpura

2:1A 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

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.

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.

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.

SJÖGREN'S SYNDROME Sjögren's syndrome (also called Sjögren'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.

NEUROMUSCULAR DISEASES

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.

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.

GUILLAIN-BARRÉ SYNDROME Guillain-Barré 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.

ENDOCRINE DISEASES

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.

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.

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.

GASTROINTESTINAL DISEASES

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.

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.

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.

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 Association15475 Gratiot AvenueDetroit, MI 48205Phone: (313) 371-8600