Autoimmune diseases are the third most common category of disease in the US after cancer and cardiovascular diseases and affect 5-8% of the population. About 80% of those affected by these diseases are women. While there is no robust prevalence data from India, it is evident that these diseases are on the rise. On the occasion of Women’s Day, Dr. Benzeeta Pinto, Consultant – Rheumatology, Manipal Hospital Old Airport Road, Bengaluru shares insights about the prevalence of autoimmune diseases in women:
Autoimmune diseases may be organ limited (eg. autoimmune hypothyroidism) or systemic involving more than one organ (eg. rheumatoid arthritis). Unfortunately, there is little awareness about autoimmune disease. Although it is clear that these diseases afflict women more than men, the exact reasons are not known. Several factors including genetic factors and hormonal changes may be contributory. Women have stronger immunity and are less susceptible to infections. This accounts for increased longevity in women compared to men.
Global data during the recent Covid-19 pandemic shows there were clear sex-related differences in Covid 19 severity and outcomes favoring women. The price for this stronger immune response is the higher risk of autoimmune diseases. The X chromosome carries numerous immune related genes and the presence of two X chromosomes in women may be one of the reasons for better immune response. Hormonal factors are also important. The effect of estrogen is manifested by the fact that autoimmune diseases in women occur most commonly in the reproductive age and decrease after menopause.
The etiology of autoimmune diseases is multifactorial and with both, environmental factors and genes playing a role. People with a family history of an autoimmune disease have an increased risk. Smoking is an important modifiable risk factor for several diseases including autoimmune disease. Exposure to drugs and toxins can also predispose one to autoimmune diseases. Other lesser clear triggers include diets rich in processed food, high carbohydrate and saturated fats, lack of exercise, psychological stress and decreased sleep. Although autoimmune diseases are more common in women of reproductive age groups, they can affect both genders and all ages including children and elderly.
Some of the common autoimmune diseases in women include Hashimoto’s thyroiditis, rheumatoid arthritis, Sjogren’s syndrome, Systemic lupus erythematosus (SLE) and multiple sclerosis. Autoimmune diseases are usually chronic and require long term treatment for control. Currently, there is no known cure for most autoimmune disorders. The treatment depends on the nature of the disease, organ involvement and severity.
Some of the disease such as Hashimoto’s thyroiditis and type 1 Diabetes Mellitus are managed with thyroid hormone/insulin replacement. Systemic autoimmune diseases like rheumatoid arthritis and SLE require drugs that modulate/suppress the immunity. Unfortunately, due to the non-specific nature of symptoms and lack of awareness, many systemic autoimmune diseases are diagnosed late after the occurrence of irreversible damage. Early diagnosis and early institution of treatment is the key to better outcomes in autoimmune diseases.
Gender bias in healthcare has also contributed to diseases in women being neglected. Some of the examples of gender bias include disbelief in symptoms (women with chronic pain being viewed as emotional or hysterical), delay in diagnosis in treatment and gaps in medical research.
While it may not be possible to change our genes and hormonal fluctuations, several other risk factors may be modifiable. Smoking is one such factor. Others include healthy diet, exercise and adequate sleep. It is crucial that women with symptoms suggestive of any of these diseases do not neglect the symptoms and get evaluated early. With appropriate treatment and support most women with autoimmune diseases can lead a normal life.