9 Autoimmune Diseases Every Woman Needs to Know About
What is autoimmune disease?
Your immune system is a multifaceted, around-the-clock security operation capable of recognizing and responding to all sorts of malicious threats by viruses, bacteria, and other bugs. But sometimes it mistakenly attacks healthy cells instead of the bad guys.
“What makes it an autoimmune disease is the fact that the immune system is producing antibodies against your own tissue,” explains longtime patient advocate Virginia T. Ladd, president and executive director of the American Autoimmune Related Diseases Association (AARDA).
Along with greater recognition of these conditions, there has been a steady rise in the prevalence of the diseases. “We used to think autoimmune disease is very rare. In fact, individual diseases are rare, but in a collective sense they are quite common,” says Noel Rose, MD, PhD, a pioneer in the field regarded as the “father of autoimmune disease.”
Roughly 50 million Americans are living with autoimmune disease, and 75% are women, the AARDA reports. While the reason why isn’t entirely clear, hormones are thought to play a role.
Each autoimmune disease has its own peculiar set of symptoms, yet many share similar features, such as muscle aches, joint pain, signs of inflammation (such as redness, heat, or pain), and flu-like symptoms. Fatigue is a defining symptom of many autoimmune disorders. “It’s an overwhelming inability to almost function,” as Ladd describes it.
Confirming an autoimmune diagnosis can be very tricky. Blood tests that look for autoantibodies (infection-fighting proteins that incorrectly target healthy cells, tissues, and organs) can yield positive results even when someone does not have an autoimmune disease. And testing doesn't always detect the problem, at least not early in the course of the disease. “Sometimes you have to follow the patient for a while in order for the disease to actually declare itself,” Ladd says.
Symptoms often come and go, making it even more difficult to pinpoint the problem, unless your physician happens to know that you have a family history of autoimmune disease and follows you over time.
How people fare with autoimmune disease often depends on the disorder, its severity, and other factors. A mild case of lupus, for example, may cause periodic symptoms, like skin rash, joint pain, and fatigue, and might be treated much less aggressively than a case affecting the heart, lungs, kidneys, or brain.
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Autoimmune disease treatment also varies depending on the condition. Corticosteroid and immunosuppressant therapies are commonly prescribed to reduce the immune response. Biologics developed to target cells or proteins that cause inflammation may be prescribed to prevent more serious joint or organ damage.
The key to living with an autoimmune disease is listening to your body, Ladd says. Rest when you need to, pace yourself, manage stress, and pay attention to environmental factors that may be triggering symptoms. Above all, she says, be your own best advocate to get the support you need when you need it. “And that means not being a victim of the disease,” she says.
Here are some of the more common autoimmune diseases–and what you need to know about each.
Lupus attacks the skin, joints, blood vessels, and/or internal organs, causing inflammation. Systemic lupus erythematosus, or SLE, is the most common and serious type of this disorder.
At least 1.5 million Americans have lupus, according to the Lupus Foundation of America. Lupus strikes women more than men, especially women of childbearing age.
“The difficulty with lupus is that it can manifest itself in different ways,” says Dr. Rose, a senior lecturer in pathology at Harvard Medical School in Boston. “It tends to be a multiple-system disease,” with symptoms affecting many different organs.
Its most distinctive feature is a butterfly-shaped rash across the cheeks and nose. Other common symptoms include fatigue, pain, joint swelling, skin rashes on sun-exposed areas, and fever. Lupus can also cause anemia; swelling in the hands, legs, feet, or around the eyes; chest pain when breathing; hair loss; mouth ulcers; and fingers that turn white or blue when they’re cold.
It’s believed that genetic, hormonal, and environmental factors cause lupus. Potential environmental triggers include fatigue, stress, infection, exposure to ultraviolet light, and taking certain types of medicines, namely sulfa drugs (which make people more sensitive to sunlight), penicillin or other antibiotics, and tetracycline.
Lupus treatment is aimed at easing pain and inflammation with anti-inflammatory medicines (like aspirin, ibuprofen, or acetaminophen). Depending on the severity of symptoms, some lupus patients may be prescribed corticosteroids to suppress inflammation and antimalarial drugs to decrease antibody production.
Psoriasis is common, affecting 7.5 million people in the United States, according to the American Academy of Dermatology.
There are several different types of psoriasis. The most common, called plaque psoriasis, causes red, inflamed skin patches covered by silvery scales. Psoriasis can be itchy or sore. It commonly affects the elbows, knees, scalp, and lower back. Some types of psoriasis show up on the palms, feet, armpits, or folds of skin around the genitals.
Psoriasis runs in families, but having psoriasis genes doesn't mean you’ll develop it. Environmental factors such as stress, skin injury, infection, or certain medications can spark or worsen symptoms.
Topical treatments may be prescribed for mild to moderate psoriasis. Some people may use light therapy to slow skin-cell growth. Moderate to severe cases or widespread psoriasis may be treated with oral or injectable “systemic” treatments that work throughout the body, like cyclosporine.
Multiple sclerosis (MS) usually occurs between the ages of 20 and 50, affecting at least twice as many women as men. Around 2.5 million people around the world are estimated to have MS, including 400,000 Americans.
In MS, the body’s immune system assaults myelin–the protective coating that insulates the nerves of the central nervous system–and nerve fibers themselves. The resulting damage, including multiple areas of scar tissue, disrupts communication between a person’s brain and other parts of the body.
Scientists don’t know why this happens but suspect something in the environment triggers a faulty immune response in people who are genetically susceptible.
Common MS symptoms include muscle weakness, fatigue, numbness and tingling, walking difficulties, and vision, bowel, and bladder problems. The vast majority of people with MS have a “relapsing-remitting” form of the disease characterized by flare-ups followed by periods of remission.
While MS can be disabling, people are living longer than ever before thanks to treatment breakthroughs, improved health care, and lifestyle changes, according to the National Multiple Sclerosis Foundation. Two-thirds of people with MS remain able to get around on their own.
While there is no cure, medication can reduce the frequency and severity of attacks, lessen the accumulation of scar tissue, and slow the progression of disability. Beta interferons are a commonly prescribed class of injectable drug for the relapsing-remitting form of the disease.
Compared with 20 years ago, many MS patients today can be treated “amazingly well” using these drugs, which cross the blood-brain barrier and ameliorate the disease, Dr. Rose says.
Some 1.5 million Americans–and three times more women than men–have rheumatoid arthritis (RA), a disease in which the immune system attacks and sometimes deforms the joints.
RA causes pain, swelling, stiffness, and loss of joint function, typically in the fingers, wrists, and feet, but it can affect any joint. And, like many autoimmune diseases, it can affect areas all over the body, including the eyes, skin, mouth, lungs, and blood vessels. RA may also cause anemia, fatigue, and fever.
While the cause isn’t clear, genes, hormones, and the environment are believed to influence a person’s risk for the disease. In women, RA often appears between the ages of 30 and 60, according to the Arthritis Foundation.
Medicines can’t cure RA, but they can slow or stop joint damage and ease pain and swelling. These include nonsteroidal anti-inflammatory drugs, corticosteroids, “disease-modifying” antirheumatic drugs, and biologics. People with significant joint damage may require surgery to restore function.
While more research is needed to identify preventive therapies, RA treatment has improved over the years, notes Betty Diamond, MD, professor at the Feinstein Institute for Medical Research at the Zucker School of Medicine at Hofstra/Northwell in Manhasset, New York. “You don’t see patients with rheumatoid arthritis in wheelchairs with hands that can’t hold a fork anymore,” she says.
Sometimes the body inappropriately makes antibodies that attack its own thyroid, the butterfly-shaped gland in the front of the neck. In time, the thyroid becomes chronically inflamed and cannot produce sufficient amounts of hormone needed to control metabolism.
Hashimoto’s thyroiditis (also called Hashimoto’s disease) is the most common cause of hypothyroidism, or low thyroid, in the US. It affects about 14 million Americans and is at least eight times more common in women. Hashimoto’s is most likely to appear between ages 40 and 60, and it tends to run in families. While the exact cause isn’t clear, it’s likely due to some combination of genes and environmental triggers.
Excessive amounts of iodine–from foods like seaweed, saltwater fish, and dairy products or from supplements–may worsen hypothyroidism in people with this autoimmune condition.
Symptoms of low thyroid include fatigue, weight gain, constipation, increased sensitivity to cold, dry skin, depression, and muscle aches. The thyroid gland itself may become enlarged.
People diagnosed with Hashimoto’s must take synthetic thyroid hormone and speak to their doctor about their iodine consumption.
This autoimmune condition attacks the thyroid too, but instead of destroying thyroid cells, it leads to the overproduction of thyroid hormone. Too much thyroid hormone can cause an enlarged thyroid, a rapid heartbeat, nervousness or irritability, frequent bowel movements, weight loss, and sleep problems. Many people with Graves’ disease develop eye problems like swelling or bulging eyes. Less commonly, it can cause reddening and thickening of the skin on the lower legs and tops of the feet.
Graves’ disease is the most common cause of overactive thyroid (hyperthyroidism) in the US. It affects about one in 200 people and is up to eight times more common in women than men, according to the American Thyroid Association.
What causes Graves’ disease? No one knows for sure. Genes, hormones, and environmental factors, including stress, pregnancy, and infection, may play a role.
Typically, patients are given antithyroid medicines to control, but not cure, their hyperthyroidism.
“If that doesn’t work, we can either partially or fully destroy the thyroid,” Dr. Rose explains. That can be done with surgery or with radioactive iodine, which is taken in a pill and absorbed by the thyroid, where it destroys thyroid cells. You’ll likely need to take thyroid hormone to replace what your body no longer makes if you undergo one of these options.
Type 1 diabetes
In people with type 1 diabetes, the body’s immune system mistakenly attacks insulin-producing cells in the pancreas.
Insulin is a hormone that helps blood sugar get to the cells of the body for energy. Without it, the body’s cells starve and blood sugar levels spike, causing damage to the heart, eyes, kidneys, and nerves. Without treatment, type 1 diabetes can lead to coma or death.
More than 1.2 million Americans have this autoimmune form of diabetes, which is usually diagnosed in children and young adults. Symptoms include extreme thirst, hunger, frequent urination, fatigue, weight loss, slow-to-heal sores, numbness or tingling in the hands or feet, and blurry vision.
Why the body turns on itself in this way remains unclear. Most people inherit risk factors, but environment is also important: Type 1 diabetes occurs more often in cold climates, and viruses and early diet may also play a role, according to the American Diabetes Association.
The goal of treatment is to maintain normal blood sugar levels through diet, exercise, blood sugar monitoring, and medication–specifically, taking insulin.
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There are only a handful of autoimmune diseases with a well-known trigger, says Dr. Rose. “The poster child for that is celiac disease.”
When people with this autoimmune condition consume gluten, a protein found in wheat, rye, and barley, their immune system responds by attacking the small intestine. The resulting damage prevents the body from properly absorbing nutrients from food–and that can pose long-term health risks.
Celiac disease tends to run in families. If you have a parent, child, or sibling with this disorder, you have a one in 10 chance of developing it yourself, according to the Celiac Disease Foundation. Researchers estimate that celiac disease affects one out of every 100 people and that 2.5 million Americans have it but haven’t been diagnosed.
In children, celiac causes a plethora of digestive symptoms, such as bloating, vomiting, chronic diarrhea, or constipation. In adults, GI symptoms are less common, while other symptoms–such as fatigue, anemia, missed menstrual periods, or osteoporosis–might signal an underlying problem.
The good news is that symptoms go away when you stop eating gluten, Dr. Rose says. That's why standard treatment for celiac disease is sticking to a gluten-free diet.
Vasculitis is an umbrella term for a group of disorders in which the immune system attacks and inflames the body’s own blood vessels. The damage can impede blood flow throughout the body, depending on the vessels and organs affected. Most forms of vasculitis are rare and the causes are unknown. It can occur by itself or with other diseases, such as lupus.
Giant cell arteritis (formerly called temporal arteritis), the most common form of vasculitis in adults, strikes after age 50 and affects more women than men. Symptoms include headache, fatigue, loss of appetite, weight loss, jaw pain, and fever. It can also cause vision loss.
Granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis) affects the sinuses, lungs, and kidneys.
Steroids, such as prednisone, can help reduce inflammation, while immune-suppressing drugs may be prescribed to decrease the body’s immune response. Another option is rituximab, a newer cancer therapy being used to treat some autoimmune diseases, including certain types of vasculitis. “We need to learn more, but there are certainly lots of examples where one [chemical or compound] is treating multiple diseases,” Dr. Diamond explains.