“Horror autotoxicus” is the way it was first described by Nobel Prize winner Paul Ehrlich (1854 – 1915). Autoimmunity is the treasonous way in which the body’s protective mechanisms turn inwards, with serious if not deadly consequences. Immunity exists to protect us both from outside invaders (such as bacteria and viruses) as well as internal saboteurs, such as cancer cells. However, when immunity turns on one’s own tissues, autoimmune diseases may occur.

The National Institute of Health identifies some 80 autoimmune diseases. The most common include Hashimoto’s thyroiditis; diabetes; rheumatoid arthritis;  lupus (SLE); multiple sclerosis; scleroderma, and Sjogrens syndrome It is estimated that 23.5 million Americans are affected, and the prevalence is rising. While some autoimmune disorders (such as diabetes and multiple sclerosis) involve specific organ systems, others (such as SLE) typically involve multiple systems.

Although autoimmune disorders can affect most any tissue in the body, when it comes to gender they are much more discriminating: 75 percent of patients are women.  Autoimmune disease is one of  the top ten causes of death in women under 65. Moreover, these diseases represent the fourth largest cause of disability among women in the United States.

Unfortunately, many of these illnesses are difficult to diagnose. According to one survey, more than 45 percent of patients are labeled as “chronic complainers” early in their illness.

Why the gender difference? It is known that women make more antibodies and have higher levels of globulin than men, and their immune cells (lymphocytes) are more reactive than men’s. It is postulated that, from an evolutionary point of view, some of these differences may be related to pregnancy. And while autoimmunity is more common in women, infection seems to be more common in men.

Both environmental as well as genetic factors influence these diseases.  For example, it is thought that in SLE, sex hormones play an important role. The female-to-male ratio among lupus patients is 9 to 1!  In its most severe forms, lupus can affect the kidneys, lungs, heart, blood, joints, skin and other systems. Lupus typically strikes women in the prime of life, often during pregnancy. In some cases it is associated with miscarriages.

But sex hormone levels are not implicated in all predominantly female illnesses. For example, in rheumatoid arthritis (RA), genetic factors are thought to play an important role. If a woman’s mother and sister have RA, there is an increased chance that she will also develop it. Genetic factors are also important in lupus, scleroderma, diabetes, and autoimmune thyroid disease.

Sometimes the symptoms of autoimmune diseases can be quite specific, such as the typical skin changes of lupus or scleroderma, or the swelling, heat, and redness of joints in rheumatoid arthritis. But many symptoms are vague and non-specific, and are frequently also found in non-autoimmune conditions. They include malaise, fatigue, changes in weight, fever, and muscle and joint pain. Patients with autoimmune diseases often feel like they are “coming down with the flu,” but the typical sore throat and runny nose never develops. Most viruses are of short duration, so if symptoms continue or worsen over weeks to months, an evaluation by a rheumatologist is prudent.

Fibromyalgia and chronic fatigue syndrome have some of the same features as autoimmune diseases, such as fatigue, malaise, and joint and muscle pain, but autoimmunity has not been implicated in these conditions.Women going through menopause may also have some of these symptoms, but autoimmune diseases typically occur at younger ages and are rarely exacerbated by menopause.

Research is making enormous strides in the treatment of these illnesses, although much is still to be done. Thankfully most of the autoimmune diseases, if diagnosed properly and early in their course, lead to excellent outcomes.  So if you’re concerned about having an autoimmune disease, know your family history,  keep track of your symptoms, and alert your doctor to your concerns.

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