Why women have more autoimmune diseases

Autoimmune disease and women
Autoimmune diseases are like a silent epidemic. Statistics vary depending on which autoimmune diseases are included. Somewhere between 23.5 million to 50 million Americans or about one in six people live and cope with autoimmune diseases according to the American Autoimmune Related Diseases Association. The National Institute of Health reports 75 percent of those people are women and has officially designated it a major women’s health issue.

“Autoimmune diseases occur when the body’s immune system becomes misdirected and attacks the organs it was designed to protect. They are a varied group of more than 100 illnesses that involve almost every human organ system,” according to Catherine Bakewell, MD, a rheumatologist at Intermountain Healthcare. “They include diseases of the nervous, gastrointestinal, and endocrine systems, as well as the skin and joints and connective tissues, eyes, blood and blood vessels.” 
 

Far more women than men have autoimmune diseases

“There are lots of theories, about why women have more autoimmune diseases, but we don’t have definitive answers,” says Dr. Bakewell. “Hormones play a role and inflammation causes a role. Men have hormones too, but women are still affected more. Estrogen predisposes women to autoimmune diseases.”

Dr Bakewell gives a few examples. Some women with an autoimmune disease can go into remission during pregnancy. During pregnancy, the body wants to protect the body and the baby. But, diseases like rheumatoid arthritis may flare fairly severely after she delivers her baby. We see that women have lower incidence of gout pre-menopause than they do post menopause. DHEA, a mild androgenizing hormone can help those with Lupus. 

The five most common autoimmune diseases are:

  1. Rheumatoid arthritis
  2. Hashimoto’s autoimmune thyroiditis
  3. Celiac disease
  4. Graves’ disease
  5. Diabetes mellitus, type 1

Many types of providers treat these. Rheumatologists don’t treat all of these. You may need an endocrinologist, gastroenterologist, etc.

Autoimmune diseases are typically difficult to diagnose

  • Symptoms cross many medical specialties and can affect all body organs. Rashes, neurologic symptoms, etc. 
  • Initial symptoms are often intermittent and unspecific until the disease becomes acute.
  • General medical providers receive minimal education about autoimmune disease.
  • The conditions are so complex, there are a variety of specialists, making it difficult to understand relationships among the various diseases or advances in treatment outside their own specialty.
  • Research is mostly disease-specific and limited in scope. More information-sharing is needed.

When doctors share medical records, it can aid in diagnosis and reduce costs

“At Intermountain, we have so many physicians under one roof and we share electronic medical records, so one provider can see what another provider thought and what labs were ordered, or treatments were prescribed. This helps us come to a diagnosis and helps us reduce costs by not ordering duplicate labs,” says Dr. Bakewell. 

Depending on the autoimmune disease you have, you may need to see a rheumatologist or an endocrinologist.

“Pain and fatigue are complex and are the symptoms of other diseases. We all experience pain differently, says Dr. Bakewell. “Some people may dismiss symptoms. Sometimes symptoms are not severe, but inflammation may be there in healthy people. We may find out patients have something besides an autoimmune diseases too.” 

Autoimmunity is known to have a genetic basis and tends to cluster in families as different autoimmune diseases — a mother may have lupus; her daughter, juvenile diabetes and Hashimoto’s thyroiditis; her sister, Graves’ disease; and her grandmother, rheumatoid arthritis.

There's a tendency to develop autoimmune diseases in families or within one individual. Once you have one disease, you are more likely to develop others. Research in the last decade indicates it’s one of the most promising research areas especially as more data is available about genetics. 

Triggers for autoimmune diseases

What we know in rheumatoid arthritis (RA) is there is a genetic basis. People who smoke smoking, cigarettes or have periodontal disease are at higher risk. There are two types of bacteria that can lead to RA. Stress can also be a factor. This is important for women to address as they are busy working, raising families, taking care of parents, etc. and have to keep the household running.

Ways to prevent autoimmune diseases

Some patients may have a blood test that identified disease, but don’t have symptoms. To help prevent development of autoimmune diseases symptoms, Dr. Bakewell recommends eating a healthy Mediterranean diet. It’s plant-based and focuses on whole grains. Get regular exercise, reduce stress, and get good sleep. Take omega 3 fatty acids, one gram per day, and be sure they’re mercury free.

Rheumatoid arthritis (RA) is the most common autoimmune disease

1.5 million Americans have RA and it affects twice as many women as men. Rheumatoid arthritis is an autoimmune disease that involves multiple joints in symmetric fashion. It affects the hands, feet, and every other joint except the spine. It causes synovitis. This is when excess fluid develops around the joints and becomes thicker. It’s the tissue that produces joint fluid and lubricates the joints. When the body’s immune system mistakenly attacks the joints and the tissues around them, they become inflamed. RA can also affect the lungs, skin or blood vessels. Early treatment is best.

If RA inflammation goes unchecked, it can damage cartilage, as well as the bones themselves. Joints can become loose, unstable, painful and lose their mobility or become deformed. Joint damage cannot be reversed, so early diagnosis and aggressive treatment is recommended.